National Health Service

HC Deb 21 October 1991 vol 196 cc660-738

Mr. Speaker

I must announce to the House that I have selected the amendment in the name of the Leader of the Opposition and that, because no fewer than 44 right hon. and hon. Members have already sought leave to speak in the debate and hope to be called. I therefore propose to put a limit of 10 minutes on speeches between 7 and 9 o'clock.

4.51 pm

The Secretary of State for Health (Mr. William Waldegrave)

I beg to move, That this House welcomes the record extra resources provided for the NHS and the substantial increase in the number of NHS patients treated since the Government came to office in 1979; supports the Government's reforms of the NHS which are already bringing about improvements in patient care; deplores the intellectual bankruptcy of Her Majesty's Opposition which, bereft of any coherent proposals of its own for the modernisation of the National Health Service, is reduced to peddling smears and scares which lower morale amongst NHS staff and cause wholly unnecessary fear amongst patients; notes with approval the Prime Minister's unequivocal statement on the NHS that there will he no charges for hospital treatment, no charges for visits to the doctor, no privatisation of health care, neither in part nor as a whole, now or in the future; and welcomes his unequivocal assurance that Trust hospitals remain a permanent part of the NHS. The Government have chosen to hold this debate today to show the House and the country three things. First, we intend to nail the falsehood that was put at the heart of Labour's campaigning ever since the notorious Monmouth by-election—that the Government intend to privatise health care in Britain and that NHS trusts are leaving the health service. Secondly, we intend to dissect and record for the House the increasingly desperate and contradictory shifts of line made by Labour over the past few weeks, as it has been forced to retreat from allegations which it knows to be false. Thirdly, we intend to demonstrate to the House what is already established among independent experts and commentators outside —that Labour has no serious policy for management of the health service and no position that stands up on money for health, and that it is our domination of the real agenda which has forced it to resort to a truly scurrilous campaign of smears and scares.

I will start by nailing once and for all the falsehood about privatisation. First, let us remember Labour's first version of that falsehood. It started with mendacious leaflets at Monmouth saying that the local trust hospital would be leaving the NHS. It went on with the right hon. Member for Manchester, Gorton (Mr. Kaufman) saying that the Prime Minister would privatise health just like coal and steel. Then we had the hon. Member for Livingston (Mr. Cook) saying, "We all know what the Tories do with nationalised industries, don't we? They privatise them," and the hon. Member for Copeland (Dr. Cunningham saying, "They will finish up selling off hospitals and privatising the health service".[Interruption.]

Before Labour Members who are less well briefed start to cheer, I should point out that those were the allegations endorsed by the Leader of the Opposition's speech writers in Brighton, when their leader said: The Tories will privatise the Health Service. It was simple. It was straightforward. It was false. But that is not what Opposition Members are saying now. The trouble with accepting advice from the ragbag collection of advisers who make up Labour's policy now is that it does not have to face interrogation from this House or from interviewers outside. Under those pressures, Labour has been redrafting and redefining—like the late Dr. Bowdler trying to rewrite Shakespeare without the naughty bits. We get six redefinitions a day; we get backing and filling; we get wriggling; and finally we get retreat.

It took six pages of the transcript of the hon. Member for Livingston's interview with Mr. Walden for that redoubtable interviewer to get to the truth. Mr. Walden said: Ah, well, now it's becoming clearer to me, and how wise we were to have this discussion, because you are not saying, are you, that the Conservatives intend to sell off the public institution called the National Health Service to private interests? Then came the answer from the hon. Member for Livingston:

"No".

So much for his leader, so much for the hon. Member for Copeland—wherever he is—who rejoices in the title of Labour's campaign co-ordinator; so much, for what it is worth, for the right hon. Member for Gorton—people always seem to be treading on him, poor fellow. The hon. Member for Livingston admits that the answer to the privatisation smears which his colleagues have perpetrated is "No". The hon. Gentleman should have the courage here and now to give the same clear, single-syllable answer to this House that he shared with Mr. Walden and the viewers. Why does he not just give us the same unequivocal "no" today?—[HON. MEMBERS "Answer."] I fear that the strings of the puppet have been pulled once again in a different direction.

Mr. Dennis Skinner (Bolsover)

On the subject of that Walden programme and retreating, will the right hon. Gentleman explain why he found it necessary to say that the Government would stop making charges for fertility treatments at hospitals such as Bart's when a letter was sent to him on 19 August saying that that was illegal, but he did absolutely nothing about it? The right hon. Gentleman retreated only when Walden asked him that question. The truth about the right hon. Gentleman is that he is educated beyond his intelligence.

Mr. Waldegrave

There is no danger of that with the hon. Gentleman. His intervention enables me to say once again, and to make it as clear to the House as I made it on the "Walden" programme—and as clear as we have made it in the past and as clear as we will make it again in the future—that one cannot do that:it is illegal to charge NHS patients.

We all know how Labour has sought to back-track in the past few days.

Mr. Tom Clarke (Monklands, West)

rose—

Mr. Waldegrave

No doubt we shall come to the hon. Gentleman in due course.

We know how Labour has sought to back-track in the past few days. We have privatisation replaced by creeping privatisation; we have creeping privatisation replaced by commercialisation, and falsehoods replaced by creeping falsehoods.

Let us examine some of the new definitions. One line is that having charges for some items of service in the NHS is privatisation. In that case, the very founder of the NHS invented privatisation. It was Aneurin Bevan who passed the legislation for prescription charges, and it was a Labour Government who introduced charges for teeth and spectacles.

There have always been some charges for some services in the NHS, under Labour and under the Conservatives. The proportion of the income of the service which comes from patient charges is actually lower now than it was in the 1950s. We did abolish universal free eye tests and dental check-ups and introduce charges for those able to pay—as is well known—and it was controversial at the time; just as Labour introduced the original charges for teeth and spectacles, and just as, in 1967, they reintroduced the prescription charge having rashly abolished it—[HON. MEMBERS:"Ah."] There has been, and there will be, no fundamental shift away from a service financed overwhelmingly from taxation.

Mr. Rhodri Morgan (Cardiff, West)

rose—

Mr. Waldegrave

If charging is to be the definition of privatisation, it was the hon. Gentleman's party who invented it. I give way to him.

Mr. Morgan

Although I did not see the programme, I understand that the Secretary of State said that it was illegal to charge for any health service except eye tests, prescriptions and those which he has just identified. If it is illegal, will he do something about the practice of one of the hospitals that serves my constituency of charging for nebulisers? It prescribes nebulisers, which are vital for people suffering from emphysema and acute bronchitis, and tells them—

Madam Deputy Speaker (Miss Betty Boothroyd)

Order. The hon. Gentleman is making a speech, not an intervention. This is delaying the Secretary of State. I think that the Secretary of State has got the point.

Mr. Waldegrave

The position is entirely clear. NHS patients cannot be charged and will not be charged. [HON. MEMBERS: "Answer the question."] I have answered the hon. Gentleman's question. NHS patients cannot be charged. [Interruption.] I have given the hon. Gentleman the absolutely clear answer that he asked for, and that is the truth.

Yet another redefinition comes from the Leader of the Opposition. Needless to say, his does not work either. In his version of the policy, he says: Up to now, care for elderly people has been free. This is an important matter. Like most of his pledges, it involves some billions of pounds of expenditure. Up to now, we have pursued a policy, supported by both sides of the House, called "Caring for People". The White Paper was supported by the right hon. Gentleman and the Labour party.

If the Leader of the Opposition is now saying that the transfer of people from wards in acute hospitals into the community, where they are supported by my right hon. Friend the Secretary of State for Social Security through the Department of Social Security, is to be abandoned by the Labour party, that is yet another commitment which involves billions of pounds of expenditure and will result in less good treatment for patients. The Labour party should come clean on that. Is it abandoning care in the community or not? If it is, that is an astonishing reversal, which would not only bring huge new pressures to bear on NHS hospitals but be worse for patients.

Then we come to the hon. Member for Peckham (Ms. Harman). Retreating off that ground, she has dug Labour into another hole. Privatisation as she defines it means high waiting lists. If that is so, Labour is the prince of privatisation. There has never been a Labour Government who did not leave waiting lists higher than they found them. What is more, as the hon. Member for Livingston knows full well, even if the hon. Member for Peckham does not, on a fair and comparable basis waiting lists fell between 1979 and now.

I give the figures for England. In March 1979, the number was 752,000. In March 1991, it was 693,000. I would like the hon. Member for Livingston to repudiate the briefing note that he has put round the country and which has been sent to me from a variety of places. It says that his figure of approximately 900,000 for now is for England, "excludes self-deferred cases"—so far, he is right —and includes waiting lists for day surgery, which were collected separately from 1987. That is totally dishonest, because the truth of the matter is that the figures were not collected at all before 1987— not that they were collected separately. The hon. Gentleman is an honest man and he should repudiate that. He knows perfectly well that he gets his higher figure by including day patients, figures for whom were not collected before 1979. He should have the honesty to admit it. [HON. MEMBERS: "Answer."] We will not get any answer.

The next argument of the hon. Member for Peckham was that we were driving people into the private sector. [HON. MEMBERS: "You are."] Opposition Members should wait before they cheer. This one lands them in a hole as well, I am delighted to say. The single year when the largest rise in the percentage of the population covered by private insurance took place was 1979—a 28 per cent. increase. No one can doubt what caused that. It was caused by Confederation of Health Service Employees pickets controlling access to the cancer wards and by the total collapse of the service. In short, Labour's running of the health service was the best recruiter for private health care that there has ever been.

Big falsehood, little falsehood, creeping smears, smears that bellow in the tones of the hon. Member for Bolsover (Mr. Skinner) or in the dulcet tones of the hon. Member for Livingston: in the past two weeks we have nailed them all. Labour took its campaign a smear too far and it knows it. It was the politics of hit and run, and the House will not let Labour Members get away with it.

Meanwhile, at Langbaurgh, the two candidates for the main Opposition parties have been following their leaders into total confusion. First, the Labour candidate. Labour's candidate in the by-election is repeating the tired and false old allegations about trust hospitals leaving the NHS. I am also told that that is not his only error. It seems that, in his election literature, he lists two hospitals as part of the new South Cleveland trust. In fact, there are three. It is a pity that his slogan is: It's time to make Langbaurgh count". Then there is the unfortunate Liberal. He has joined in with a finely printed leaflet. He was selected, the hon. Member for Bolsover may be interested to know, for his local knowledge. He has led a great campaign on the closure of the maternity unit in Gainsborough. He is not going to have the closure of the maternity unit in Gainsborough. Unfortunately, Gainsborough is in the next county—it is Guisborough. I am afraid that the candidate is a little askew.

Mr. Simon Hughes (Southwark and Bermondsey)

I am grateful to the Secretary of State for giving way, because I was in Guisborough maternity hospital this morning. [Interruption.] If the Tory candidate thinks that dealing with a printer's error which was accepted as such is a way to win a campaign, he has something else coming. I want to ask the question put to people who go to the maternity hospital, and I hope that the Secretary of State will answer it. Why do not his Government commit the resources sufficient to make sure that the NHS has the money that it needs—[HON. MEMBERS: "How much?"] I will tell Conservative Members how much—to keep pace with NHS inflation, which is above the average inflation? Why do the public expenditure plans of his Government show that the figures for the next two years are net increases of 1.2 per cent—.

Madam Deputy Speaker

Order. I have already made it clear that interventions should be interventions. They should be specific questions or comments which are to the point. It is unfair of hon. Members to seek to jump the queue in this way. I tell the hon. Member and any other hon. Members who want to intervene that I want specific questions from now on. Come on Mr. Hughes, get it over with.

Mr. Hughes

Why are the commitments in the public expenditure plans 1.2 per cent. and 0.65 per cent. for the next two years—well below the least estimate of what the NHS needs to stand still?

Mr. Waldegrave

The hon. Gentleman is suffering from what is known as post-candidate selection depression. These matters will be dealt with when the autumn statement comes out. The hon. Gentleman was honourably trying to dig his candidate out of the absurd hole into which he had fallen head first, and I pay tribute to him for that.

Mr. Tim Devlin (Stockton, South)

I wonder whether my right hon. Friend is aware that the position is in fact rather worse than he fears? When the Labour candidate in Langbaurgh was asked to explain why he thought that there were two hospitals in the trust instead of three, he said, "Ah yes, that is because only two of them are in the constituency." That makes it rather worse, because none of the three hospitals in the trust is in the constituency.

Mr. Waldegrave

Neither of the Opposition parties has been very lucky with its candidate in this particular election campaign.

The reason why the Labour party took off into the smears and scares was because of the third point, to which I am coming.

Several Hon. Members

rose—

Mr. Waldegrave

Hon. Members will doubtless make their speeches in due course.

Mr. Tom Clarke

On a point of order, Madam Deputy Speaker. You will recall that, 20 minutes ago, the Secretary of State said that he would give way to me. Is it in order for the Secretary of State for Health in England, who made statements on television yesterday about the health service in Scotland, to refuse to give way to a Scottish Member?

Madam Deputy Speaker

So far there has been no breach of Standing Orders. The Secretary of State will have heard what the hon. Gentleman has said.

Mr. Waldegrave

The reason why Labour Members went down the side track of smears and scares was because of the drubbing that they had been receiving at the hands of the experts on their policies, such as they are. Seldom has there been such a consensus among health experts— generally an argumentative lot—than there is now on the fact that Labour's positive policy on health has been an object of almost universal derision.

Ken Judge, the director of the much respected King's Fund Institute, said: One of the key difficulties"— key difficulties, mind you, not one of the lesser difficulties— with Labour's health policy is that it is not at all clear precisely what their policy for running the system is. Pamela Charlwood, director of the Institute of Health Services Management, called Labour's plans to replace the purchaser-provider division with health authorities divided into two boards as "an unworkable mess". Professor Alan Maynard of York university asked of Labour's absurd flexi-funding scheme: Where is this extra money coming from? Are there going to be closures and sackings? How do they identify successful authorities? They haven't thought it through. Dr. David Hunter, director of the Nuffield Institute, who, incidentally, has been trying to help Labour Members in one of their think tanks, said: Labour plans have not been worked through in detail. They are not convincing. They would create further turmoil and uncertainty. Yesterday he added that he feared that under Labour the NHS would not be "modernised", it would be "fossilised."

That is why there is not a single serious editorial or other commentator who takes Labour seriously on its policy. The Observer's political diarist, not in his comments a particular friend of mine, described the policy of the hon. Member for Livingston thus: He does not possess a single new idea for organisation of the Health Service. His one notion is to throw more money at it in carefully unspecified amounts. At this rate I must warn the hon. Gentleman that it will not be long before he is attacked by the Daily Mirror. After all, Labour Members have not had long. They have had only 12 years. Perhaps in another 12 years they will have a policy. We shall see that they get the time.

Then there is money. Labour Members are not very good at money. I pay tribute to the hon. Member for Livingston in one respect. He shares his favours equally; having spent last Sunday going backwards on the Walden show, he spent this Sunday going backwards on the Dimbleby show. There was the truly comical spectacle of him trying to make sense, either to himself or to Mr. Dimbleby, of his flexi-budget. It became crystal clear that, if such a scheme were ever to be introduced into NHS management, it would be a recipe for chaos. Every hospital would he encouraged to compete for incentive funds, and only the winners would be rewarded. The others would go bust. Mr. Dimbleby could not take it seriously. What was apparent also was that neither could the hon. Member for Livingston.

Far more fundamental was the hon. Member's further shifting of the ground on money. He could not define what he meant by underfunding, and he abandoned his clear previous pledge to abolish it, whatever it might be, over the lifetime of a Parliament. In passing, he had a snipe at the hon. Member for Derby, South (Mrs. Beckett) who had made it clear that only some of the alleged underfunding, whatever it might be, could be put right in a Parliament. He told her that she should not give interviews. It was a truly magnificent piece of the equivocation for which the hon. Gentleman is becoming increasingly known.

I shall tell you, Mr. Speaker, what the hon. Gentleman's formulations on spending were on Mr. Dimbleby's show. I noted them down. They started with something that almost means something: We have made a firm commitment, and I am very happy to repeat the firm commitment, that we will over the lifetime of the next Parliament—it cannot be done overnight—we will restore the underfunding of the NHS of the past decade. That was in January. Yesterday it became first, "We will", then, "We very much hope" and finally, "We will seek" —the ultimate weasel word. The hon. Gentleman will seek and he will not find.

When cornered this time, the hon. Gentleman did not take refuge behind the right hon. and learned Member for Monklands, East (Mr. Smith), his usual shelter from the stormy blast. He called in aid in a voice of awe the "ultimate authority". By that he meant—I am afraid I am not joking—"our leader, Mr. Kinnock". The latter, however—he is sitting smiling in his usual benign and somewhat vacuous way—had already involved himself in quite another pledge, involving £3 billion to £4 billion of different money.

The hon. Member for Livingston referred to such promises as "interesting contributions", "persuasive" and "a very serious figure". Finally, he said: I am not in a position to differ from them, but equally I am not in a position to validate them. As a recent leader in The Times said of Labour: Their undefined `restoration of underfunding' is designed to permit everybody, from consultants to porters, to think that Santa Claus is round the corner. They remain as ever, a gigantic soft touch.

Mr. Tom Clarke

rose—

Mr. Waldegrave

I must let the hon. Gentleman out of his agony. Come along.

Mr. Clarke

I am grateful to the Secretary of State for finally giving way. He is making it more difficult for me than Brian Walden did for him yesterday. When the Secretary of State was asked a specific question about charges in Scotland, including charges for HIV patients, and he gave the reply which led many of us to believe that those charges would be annulled, had he consulted his fellow Ministers at the Scottish Office? If not, has he now done so? If there have been consultations, when will the charges be withdrawn?

Mr. Waldegrave

There is no need to consult about what the law of the land is, and that is the end of that matter. [Interruption.] There is no lack of clarity about it whatever. NHS patients cannot be charged.

It is not just that Labour Members cannot substantiate the half-promises on resources that they have made. It is worse than that. On a range of issues, they have made unequivocal promises to reverse savings that we have made, the benefits of which we have already ploughed back into patient care. They would end, for example, the contracting out of services, which has gained us a minimum of, and probably much more than, £50 million for spending on patients.

Yesterday, the hon. Member for Livingston pledged an additional £400 million to £500 million, which would be taken from patient spending and would finance Labour's absurd minimum wage plans in the NHS. I am grateful for his unusual candour, in that he said £400 million to £500 million. He continued in a totally absurd passage to say that that would be "largely self-financing" because he would take all the money away again in tax. I believe that the hon. Gentleman may have let some small cat out of the bag about what would happen to the taxation rates of the low paid. What else can "largely self-financing" mean?

Let us get this clear: Labour is already pledged under its national insurance and tax proposals to take £20 a week from the average nurse and £70 a week from the average general practitioner. The House should be told today whether it is now pledging to reverse those cuts in take-home pay for health service workers, gross or not. If it is not, all those health service workers know that, if the Labour party is elected, they will lose in real terms, as they did under the last Labour Government. We will not get the answer to that, any more than we will get an answer to anything else from them.

The Opposition made another utterly disastrous pledge yesterday. They have promised to launch the health service down the route that Barbara Castle launched it down in the 1970s. That promise comes from the otherwise normally thought of as the oh, so responsible right hon. and learned Member for Monklands, East. Yesterday, he made it clear on yet another television show that the Labour party intended to remove pay beds from the NHS. That will take another £100 million.

That money will be lost to the NHS and given to the largely French and American-owned private sector health companies—those companies that Lord Ennals and others direct in Scotland and elsewhere. Why should the NHS not have the opportunity to make that money for patients? It could plough that money back into the system for NHS patients. Why should it be forced to lose that money? That is what Barbara Castle attempted to do and that is what brought her into total conflict not only with the British Medical Association, but with the entire health service.

Barbara Castle is an honest lady, and she wrote down in her diary the reason for the policy—the hon. Member for Bolsover knows this very well, as he reads those diaries every evening. She wrote: doesn't the Government; realise"— the then Labour Government; Ted Short was giving her some trouble on this rather absurd policy— that this is an essential political sweetener for the Unions? That is what generated the Labour Government's apology for a policy then, and that is what generates the Opposition's apology for a policy now.

Throughout the world, Governments of all political persuasions are seeking with greater urgency to match scarce resources with the increasing demand for health care. In Germany, the Netherlands, Spain, Sweden and New Zealand, the ideas that we are carrying through into practice have been paralleled, or indeed, in some cases, imitated, by other Governments.

It is right to devolve decision taking, as we are doing, to NHS trusts and to general practice fund holders. It is right to enable comparison of costs to be made by those who have to judge where to put resources. It is right to reward with more resources, so that they can do more work, those who are the most efficient at delivering high-quality health care. That is what our internal market is now beginning to do.

It is right also to raise the total level of resource to meet new needs, as we have done. At a time when other countries are seeking to rein back spending on health, we have been increasing the share of the gross domestic product that goes to the health service. In the past 10 years, there has been a full percentage point increase in spending from a bigger national product.

It is fear of those facts and of the void of their own policy that has led the Opposition to smear and to mislead. But it is not too late even now. Even at this late stage, the hon. Member for Livingston could redeem himself today before the House by setting out in paragraphs preferably a little shorter than those he used on the "Walden" programme three simple things. First, he should say that he knows the privatisation smear to be false. Let him say that and use that "no" as he did on the Walden programme. Secondly, what are his plans for the management of the health service? Let us hear about them at last. Thirdly, how much money is he going to spend? Let him say those three things to the House today. He has had 12 years: we might at least have some answers finally.

We could hardly have had a clearer example again today of the shiftiness of the Labour party on this issue. Our policy is clear. As my right hon. Friend the Prime Minister said—I repeat his words in the House today— There will be no charges for hospital treatment, no charges for visits to the doctor, no privatisation of health care, neither piecemeal or in part, nor as a whole. Not today. Not tomorrow. Not after the next election. Not ever while I am Prime Minister. That is what my right hon. Friend said, and that is the truth. [HON. MEMBERS: "Hear, hear."]

What we have achieved on spending and what we intend on policy is crystal clear. It is underpinned by clear commitments in the pledges and principles that are placed before the House today. That is why I urge my right hon. and hon. Friends to reject the amendment and to support the motion.

5.24 pm

Mr. Robin Cook (Livingston)

I beg to move, to leave out from "House" to the end of the Question, and to add instead thereof, `deplores the decision of Her Majesty's Government to ignore the evidence from the consultation period that the overwhelming opinion of the local public and health staff was opposed to the commercialisation of their health service by further units opting out of the local health service; condemns as irresponsible the approval of further trust applications in the face of the widespread financial difficulties experienced by existing trusts with their original business plans; rejects the relentless privatisation of health services by the construction of more private wings, the transfer of geriatric care to nursing homes, the increased introduction of private contractors, the decline in access to a National Health Service dental service, and the introduction of tax relief on private medicine; notes with alarm the spreading practice of charges for hospital services and the damage done to eye screening by the introduction of commercial charges for eye tests; regrets the persistent refusal of Her Majesty's Government to recognise the self-evident underfunding of the hospital service and rejects the priority attached by Her Majesty's Government to cutting taxes rather than restoring cuts in public services; and commends Labour's policy document "A Fresh Start for Health" as the comprehensive basis for renewing a public health service over the lifetime of a full Labour Government.'. The 900,000 people on the waiting lists in Britain and the 300,000 people who had their operations cancelled in the past 12 months would all regard the speech that we have just heard as wholly irrelevant to why they cannot get the health care that they need.

Mr. Peter Thurnham (Bolton, North-East)

rose—

Mr. Cook

With respect, it is not the form to intervene within the first 30 seconds of a speech.

The Secretary of State accused me of retreating on my statement. If I was so minded to retreat on anything I have said, I could not hope to rival the speed with which he moved in retreating on tax relief only yesterday. I apologise to the Secretary of State for one thing; we drafted our amendment before his revelation on the Walden programme. Had we known about that before, we would have wished to include in it the right hon. Gentleman's cheerful confession that tax relief for private medical insurance did not work very well, that not many people had taken it up and that they might as well abolish it. All we need to complete the act of repentance is a letter from the right hon. Member for Finchley (Mrs. Thatcher) to say that she was only too painfully aware that I was responsible", and was "mystified" that it was such a flop. Six months ago, at the start of a previous debate, I told the House that the scheme for private medical insurance, far from working well, was not working at all. Far from resulting in more elderly people choosing private medical insurance, all the scheme has done is provide tax handouts for people with existing policies—a tax handout at a total cost of £150 million over three years. That money would have been far better spent on the geriatric wards that the Government are closing.

That daft scheme came out of the same review that gave us the dogmatic changes to the NHS that the Government are now imposing. It was the first proposal in their White Paper to be implemented; now it is the first to be, abandoned.

After that experience, one might have thought that a touch of humility would have been appropriate among those on the Treasury Bench—possibly a passing cloud of self-doubt. Not a bit of it. Never mind the fact that the one part of their policy of which we have had two years of experience has turned out not to work very well, the Secretary of State has chosen to kick on regardless.

Last week, the right hon. Gentleman put another 99 units into his giant experiment with the health service when he made them self-governing trusts, but there is plenty of evidence that those trusts are not working very well. Central Manchester is in deficit of more than £1 million, interestingly almost half of it caused by losses on its new private wing. It is a bit like the tax relief on private medical insurance—not many people wanted to take up that option. The people of Manchester, had they been asked, would have preferred that money to be invested in national health facilities rather than in a private wing.

The Bradford trust has given us another new first in businesslike methods. At the weekend, Bradford an-nounced, for the first time in its history, compulsory redundancies of nursing staff. Mind you, the director of nursing could not bring himself to use the term "compulsory redundancy": he described the nurses as being "released". They were released because the ward in which they worked, which currently treats 34 patients a week, is to be closed next month.

In search of the common ground, let us put to one side the argument between the Opposition and the Government about whether one can close beds and increase patient care at the same time. I concede that nursing staff and others have been extremely inventive in coping with bed closures, even down to inventing "hot bedding" by which day cases occupy the beds in which in-patients sleep at night. However, I hope that Conservative Members will not now pretend that one can reduce the number of qualified nurses and increase patient numbers without the quality of care suffering. Yet the Library advises me that the next statistical bulletin will say that, in the past year, 3,000 fewer nurses have been employed in the health service, at the very time when the Government have increased the number of administrators by 4,000.

The subject of administrators logically brings me to Guy's hospital, where we find the best paid health administrators. Guy's currently spends more in its business budget for the current year and is receiving less in revenue than it expected in the current budget. Estimates of how much less revenue it is receiving are subject to a wide margin of error. In the case of work outwith the main block contracts, the estimates of how much has gone unpaid vary from an official figure of 50 per cent. unpaid to an unofficial figure of 95.5 per cent. Guy's response has been another business first for the NHS: it has sent packing its director of finance, with a farewell deal of £200,000 plus his BMW car. Is that what the Secretary of State meant when he promised to bring modern business practices to the NHS? Where is the value for money for patients in that?

Mr. David Wilshire (Spelthorne)

Before the hon. Gentleman knocks management and administration too much, will he comment on the fact that some 3 per cent. of NHS employees are managers, whereas Britain's biggest manufacturing industry has over 20 per cent?

Mr. Cook

Absolutely. The hon. Gentleman's question goes to the heart of why we resist the Government's changes. The kind of market that they propose cannot be run without a much larger army of administrators than any business ever has. If the hon. Gentleman wants to compare the NHS with the private medical sector, never mind private industry, he will find that the administration in the NHS is half the level of the private medical sector. Why, then, should we copy their methods? Surely they should copy ours.

We know that the Secretary of State recognises those problems. He has not managed to muster the same candour as he did in relation to tax relief, but he has kicked into touch the other applications for trust status in London. Instead, we are to have a committee of inquiry for London. It is more than a year since I published a leaked document from his Department warning Ministers —admittedly, his predecessor—of the consequences of a market for the London health service. It warned that the consequence would be "unplanned downsizing", and that at least one major hospital would be put at risk. However, the Secretary of State's predecessor did not listen: he simply ploughed ahead. The Secretary of State even allowed Guy's to become a trust, although we now know that it had the worst of six ratings for financial viability from his independent advisers.

A year later, nine out of the 12 London teaching hospitals are in deficit. Some of them are contemplating severe downsizing. In the fix that the Secretary of State got into, he was absolutely right to appoint a committee of inquiry, but it was absolutely wrong for him to go ahead with his risky experiment without having a committee of inquiry at the beginning.

Mr. Andrew Rowe (Mid-Kent)

Will the h on. Gentleman explain why, with a rapidly falling population, London should be so grossly over-hospitalised, while areas like mine have been deprived of much-needed resources for many years because of the concentration of resources in London?

Mr. Cook

Let us take the logic of the hon. Gentleman's question. He says that London is over-hospitalised and there is over-capacity. One could challenge that statement, but let us accept the premise of the question. If there were surplus capacity, surely competition in a health market would work. Surely this would be the one place where there would be a buyer's market and where practices could drive a hard bargain on behalf of the patients. If the Government really believe in the market, why have they now had to admit that the only way to run a public service is by proper, sensible public planning?

If the Government have decided that, in this case, where they have surplus capacity, they cannot run a market in which there is competition, why are they promoting a market in health care without the benefit of a committee of inquiry in places such as Aberdeen, where the only hospital for 15 miles in any of three directions is a hospital that is applying to become a trust? Where is the competition in that? What conceivable gain can be achieved by creating a market for that one hospital? Consultation on the application for that trust for Forresterhill hospital closed in the same week as the by-election in Kincardine and Deeside started.

Were the Secretary of State a resident of my home town of Aberdeen and a voter in Kincardine and Deeside, he would have some difficulty when he went to the polling booth for the by-election and sucked his pen, because every candidate in the by-election is opposed to his policy. I cannot tell the House the results of the by-election but I can give the results of the consultation on the application for trust status for Forresterhill hospital. A total of 3,919 responses were received; 13 were in favour of the application for trust status; and almost 3,900 recorded opposition to the trust. How can there be any doubt about the response to that consultation? How can anyone pretend that consultation would be anything but a sham if the Government even contemplated approving it? How can the Government seriously hope to fight a by-election—

Mr. Ian Taylor (Esher)

Answer the questions.

Mr. Cook

If Conservative Members want questions, they should answer this question before that by-election: what will the Government do for Forresterhill hospital, and will they make it opt out once polling day is out of the way? Moreover, since Conservative Members are so keen on questions, let me ask another question that we asked last week and to which we are still awaiting an answer.

Mr. Roger Gale (Thanet, North)

Will the hon. Gentleman give way?

Mr. Cook

No. Conservative Members wanted questions and we shall give them questions. Does it never cross their minds that, when the public are so opposed to a proposal, it is just possible that the public are right? The public are right to believe that they would get better health care if an integrated public service was retained rather than broken up into competing businesses.

This morning, the Secretary of State said that he did not understand what we meant by "commercialisation". Let me try to help. Last summer, I asked for the business plans of hospitals seeking to become trusts in this round. Three out of four refused. Interestingly, the most common reason for refusing—

Mr. Phillip Oppenheim (Amber Valley)

Will the hon. Gentleman give way?

Mr. Cook

I can never refuse the hon. Gentleman. I shall give way when I have finished this passage.

Mr. Waldegrave

The hon. Gentleman has gone off, in his usual way into past speeches. Will he answer the questions that I asked him? He gave no answer whatsoever to the three questions that I put to him. Will he now honour the House with his confidence and give those three answers?

Mr. Cook

If the Secretary of State is patient, he will get to those passages and he will have some answers. I do not promise that he will like the answers, but he will certainly get some.

First, may I help the Secretary of State on the term "commercialisation"? The most common reason given by those hospitals that refused to release their business plans was that the information that they contained would be of value to a commercial competitor.

Mr. Jerry Hayes (Harlow)

Will the hon. Gentleman give way?

Mr. Cook

No. I have already made a promise.

We have already damaged the health service. If, even before those hospitals become trusts, they no longer regard other hospitals as partners in the same public service but as commercial competitors—

Mr. Oppenheim

As I know that the hon. Gentleman will have carefully costed the Labour party's proposals for the NHS, will he say by exactly how much he believes the NHS to be underfunded? Will it be the priority of a future Labour Government—should one come to power—to redress that underfunding?

Mr. Cook

Yes, it will be a priority of the next Labour Government. The Labour party's Front Bench team all understand that that will be one of the key ways in which the next Labour Government will be tested.

Mr. Waldegrave

Will the hon. Gentleman give way?

Mr. Cook

I shall happily give way to the Secretary of State, but I am still replying to his hon. Friend the Member for Amber Valley (Mr. Oppenheim).

Mr. Waldegrave

For the aid of the Hansard writers, we heard the hon. Gentleman say "a priority". Will he now say, among all the other priorities, how much would be spent?

Mr. Cook

Both those questions are now of such antiquity that we should send them for carbon dating. Let me respond—[Interruption.] There is not much point in Conservative Members asking questions if they will not listen to answers.

I shall respond by stating quite plainly what we have said on funding. First, each year we shall ensure that, if we approve a pay award in the health service, we shall fully fund it in a way that the Government have never done since 1985. Secondly, when we produce our budget for the national health service, we shall fully take into account the pressures on the budget of the growing numbers of the very elderly in our community—the very people who created the NHS and who, cruelly, now find that they cannot use it when they need it. Thirdly, in the first year we shall start to tackle underfunding and shall continue to do so year on year.

Mr. Hayes

The hon. Gentleman really must come clean. Thousands of people saw him on the Jonathan Dimbleby progamme yesterday and saw Mr. Dimbleby ask the hon. Gentleman about the £4 billion of underfunding that the Leader of the Opposition talks about and the £6 billion underfunding that the British Medical Association talks about. The hon. Gentleman replied that he was not in a position to validate the estimates. How can anyone believe him?

Mr. Cook

The hon. Gentleman and I had the same exchange during the last debate, in which the hon. Gentleman accused me of not being serious because I said that it could not be done overnight. Having watched the Conservative party conference I understand that, for the hon. Gentleman, "overnight" is rather a long time. Nevertheless, the position remains precisely the same; over the lifetime of the Parliament, we shall seek to restore the underfunding, and in each year we shall make progress towards achieving that end. In precisely—[Interruption.]

Madam Deputy Speaker

Order. This is a most serious debate. Millions of people outside the House, as well as those inside it, are listening to the debate, so let us have it conducted in good order so it might be properly recorded so that they may understand it.

Mr. Cook

We shall do it next time because we did it last time. The last Labour Government—

Several Hon. Members

rose—

Mr. Cook

Conservative Members will have to listen to the facts now.

Inside five years, the last Labour Government provided more extra nurses and doctors for the NHS than the Government have done in more than 10 years. Every year, we increased the real resources to the health service by twice the amount that the Government have done. If Conservative Members are seriously going to contend that the—

Dr. Keith Hampson (Leeds, North-West)

On a point of order, Madam Deputy Speaker. There was a gross inaccuracy in the hon. Gentleman's statement. The only time during the past 20 years when there was a real cut in NHS spending was in 1977.

Madam Deputy Speaker

That was not a point of order at all.

Mr. Cook

If Conservative Members are seriously going to contend that there is no underfunding of the health service, as appears to be the basis of their chant, let them try to tell that to Maria Mullhall. Let the Secretary of State try telling her about equal access to free health care. Last year, her father's heart operation was cancelled. This year, her father had a second heart attack.

Mr. Gale

On a point of order, Madam Deputy Speaker.

Mr. Cook

I can understand why Conservative Members do not want to hear this.

Madam Deputy Speaker

I shall take the point of order, which I hope is genuine.

Mr. Gale

Madam Deputy Speaker, a few moments ago I distinctly heard you say to Conservative Members that thousands of people outside the House were waiting to hear the answer to a question. Could you instruct the hon. Member for Livingston (Mr. Cook) to give it?

Mr. Cook

I can understand why Conservative Members do not want to hear about the real effect of their policies on real people. As the House well knows, the people outside the Chamber know the reality of what is going on in the health service, and they want to hear that reality expressed from the Opposition Dispatch Box during this debate. Conservative Members will not be allowed to silence that.

Maria Mullhall's father suffered a heart attack this year, having had his heart operation cancelled last year.

Mr. Ian Taylor

The hon. Gentleman is wriggling.

Mr. Cook

I am not wriggling. Conservative Members do not want to hear what is happening in the health service under their Administration.

Maria Mullhall rang 999 for an ambulance.

Mr. Patrick Nicholls (Teignbridge)

On a point of order, Madam Deputy Speaker. You reminded the House that the public would be watching this debate—

Madam Deputy Speaker

Order. I reminded the House that millions of people outside the House take this matter seriously, and the House should do likewise. We must hear this debate in the good order that this debating Chamber demands. I call Mr. Cook.

Mr. Nicholls

On a point of order, Madam Deputy Speaker.

Madam Deputy Speaker

Order. I have heard the hon. Gentleman's point of order and he must now resume his seat. I call Mr. Cook.

Mr. Cook

I very much hope that Maria Mullhall is one of those watching this debate, because she will see the depth of concern being expressed. When she rang for the ambulance, for 15 minutes she was connected to an answering machine asking her to hold. Her father died while she was connected to that answering machine. When asked to comment on the matter, a spokesman for the ambulance service said that the answering machine was used "when demand is excessive".

How is it possible for a fatal heart attack to be described as an excessive demand? How can Conservative Members go on denying that there is underfunding when the system cannot handle an emergency call for a heart attack? There were no answering machines under Labour.

Mr. Waldegrave

May I remind the hon. Gentleman what happened to the emergency services when the Labour party was last in power? The Confederation of Health Service Employees was controlling access to hospitals and the ambulances could not get into the hospitals.

Mr. Cook

One of the reasons why people outside this House find it impossible to trust this Government's commitment to the health service is the open contempt with which they talk about most of the people who work in the service. One thinks of the contempt with which the Secretary of State quoted the Confederation of Health Service Employees at the Conservative party conference. He quoted the general secretary of COHSE as demanding that his members should push for a health service that acts in the interests of its staff". The Secretary of State got his applause at the party conference. It is a pity that he did not read what the general secretary of COHSE had actually written. He had called on his members to push for a health service that acts in the interests of its staff and the people who rely on it. What word can we use to describe that deliberate misquotation? What word will the Under-Secretary find in his well-thumbed Collins dictionary to describe it? How dare they accuse us of lying?

Maria Mulhall's experience was not unique. Dr. Michael Joy, a GP in Surrey, has done an analysis of his heart patients over the past 10 years and found that, in that period, 15 of them died on waiting lists for operations. None of them died while waiting for private operations.

It is difficult to do justice to the fury of the patients who write to us after being told that they will have to wait for more than a year for their operations and after learning that, if they had the money, they could have the same operation with the same surgeon in the same hospital in little more than a week. Patients call it privatisation when they see more private wings in NHS hospitals providing a fast track for patients who can pay. In Doncaster, the wards closed by the trust hospital are being reopened by an American private hospital company. In Newark, the proposal before the health authority is for 50 acute NHS beds and 50 private sector beds at a hospital designed from the start to have a first-class and a second-class compartment.

Patients call it privatisation when they find that geriatric wards are closed and patients are put in private nursing homes. How would Conservative Members who are seeking to intervene in this debate respond to the moving letter that appeared in a national newspaper last week from a man whose wife was admitted to hospital with terminal cancer and who described how his distress in her last months was increased by pressure to get her out of the NHS hospital and into a private nursing home? That took place in a hospital with 60 closed geriatric beds standing empty—a hospital that found the money and the land to build a private wing for private patients. I can tell Conservative Members what this gentleman calls that. He says: Not only is a form of privatisation taking place, it can be seen and it can also be experienced.

Mrs. Edwina Currie (Derbyshire, South)

Will the hon. Gentleman clarify what he has just said? Is it now Labour party policy to nationalise all the hundreds and thousands of first-class private residential care homes and nursing homes throughout the country and to put their occupants back, 30 or 40 to a ward, into NHS geriatric wards?

Mr. Cook

Of course that is not our policy. Our policy —this should be the duty of any Government charged with the management of the NHS—is to make sure that those patients have a choice between public and private sectors, and that they are not confronted with a private sector monopoly.

Patients call it privatisation when they discover that the dentist will treat them only if they go private. The day the Prime Minister made his speech on not privatising the health service, patients at a practice in Devon received a letter from their dentist telling them: As from January 1992 we shall no longer be able to offer NHS treatment to our fee-paying adult patients. The contrast between what the Prime Minister said and what they were told was so stark that three separate patients of the practice in question sent me the letter, saying: It surely is privatisation by the back door. Patients call it privatisation when they discover that they have to pay for what used to be free. I was extremely interested to hear the Secretary of State say yesterday that it was illegal to charge NHS patients. I was sorry to learn from this morning's papers, however, that, when asked, his Department could not find a single case in which he had intervened to stop such charging.

Scarborough health authority has sent a letter to those who used to receive incontinence aids: You will be aware that, in a modern"—

Mr. Ivan Lawrence (Burton)

Nonsense.

Mr. Cook

In that case, it is nonsense from health authorities acting under a Conservative Government. You will be aware that, in a modern NHS, each health authority has to look carefully at costs and expenditure. After careful thought I have therefore decided that the free supply of incontinence aids can no longer be sustained. So patients on income support find that they are being charged for incontinence aids that once were free.

What will the Secretary of State do about Bart's, where this morning it was discovered that some patients coming for fertility treatment are being asked to pay £350 of the £800 cost? Will the right hon. Gentleman stop that after this debate? What will he say to the woman in Ipswich who wrote to me because 12 years ago she injured her spine and was given a free appliance to help with the pain? She finds that this month she will have to pay £70 to replace the appliance. What will he say to this woman of 72, so poor that even under the present rules she qualifies for housing benefit? She says: Yes, it is creeping privatisation of the NHS". These are not our words: they are the words of the patients who know what is happening. Are they too lying when they describe what happens to them?

Mr. Devlin

Perhaps we could move a little further north, from Scarborough to Langbaurgh, where on Thursday the Labour candidate said that hospitals that opt for self-governing status opt out of the national health service. On the same day, the hon. Member for Middlesbrough (Mr. Bell) said in the Evening Gazette that hospitals that become trusts remain part of the NHS. As the hon. Member for Middlesbrough is sitting in front of the Langbaurgh candidate's friend, perhaps the hon. Gentleman would like to introduce them?

Mr. Cook

The hon. Gentleman clearly came here with instructions to get his sound bite in for the local press. I was foolish enough to imagine that he was going to say something relevant to the debate—but I think it time that we made progress. People who find that their health service treatment is slipping away from under them will remember the total indifference that the hon. Member for Stockton, South (Mr. Devlin) showed on this point.

We shall not let the Secretary of State come back to this House after what he has said about charges being illegal without hearing whether, after this debate, he left the Chamber and stopped those charges.

Quite properly, Madam Deputy Speaker, you do not allow us to use the word "lie" of each other in this House, but the rules do not prevent me from reporting that the word has been used against me time and again in the past three weeks—although not in this Chamber. It has not been used to my face, when I am in a studio—it is always said when I am not there to answer back. No one has raised the charge more often than the Secretary of State, whose routine response to criticism now is to brand it a lie.

The reason for the Chamber not allowing the use of the word "lie" is well-founded: it is that we cheapen and degrade public debate when we reduce it to the level of personal abuse. The politician who forgets those rules will pay a high price. It is a price that is exacted by a public who will treat with contempt any politician who would rather abuse his opponent than answer the charges. After a fortnight of abuse by Conservative Members, the voice of the nation was heard last weekend, in a poll which gave health as the largest single reason why people would not vote for this Government.

The Secretary of State had some fun at the expense of our policies. He has clearly been through our document "Fresh Start for Health". It is the fullest, longest, most comprehensive health document ever produced by an Opposition. Before coming to the debate, I went to the Oriel room and requested the documents that the Conservative party produced on health policy before the 1979 election. I was told that none could be found.

So that the Secretary of State has no doubt about our policies and why the public prefer them, I shall tell the House what our policies are. First, we shall rebuild the NHS as a public service and bring back into the local health service those hospitals that have gone it alone as trusts. We shall not bring them back into health authorities that represent just the Secretary of State of the day, but into health authorities that represent local communities. We shall set each of them a performance agreement which will tackle the variation in performance which Conservative Members keep identifying and never tackle.

We shall offer pressure and incentives to improve the performance of health authorities that are failing in public service while Conservative Members offer only the risk of downsizing and closure in a health market. We call our document "Fresh Start for Health" because Conservatives have imposed on the health service a wrong agenda with the wrong priorities. That was plainly demonstrated last year, when the Government discovered that they could not afford their changes to the national health service and to community care and therefore chose to plough ahead with their unpopular changes to the NHS but to delay changes in community care until 1993.

It is not care in the community to take patients out of a geriatric ward and put them in a private nursing home. That is simply transfer from a public institution to a private institution. Real care in the community is provided by those local authorities which supply the home help service, the authorities that are in the top 20 in the league of home help provision—every single one of them a Labour authority. That is why we shall introduce a community care grant to support the work of those local authorities. We shall ring-fence that grant to make sure that the bottom 20 authorities, none of which are Labour, have to spend that money on the care of the elderly.

We shall create a level playing field in residential care to end the nonsense by which the biggest subsidy from central Government goes not into public residential care but into private residential care. We shall take the action that the Government have failed to take to make a reality of their targets in health promotion, such as banning tobacco advertising to stop pressure on young people to take up the habit and bringing in random breath testing to stop alcohol abuse. We shall undo the criminal damage that the Government did to the screening service when they introduced charges for eye tests. We shall restore the free eye test so that no one will have to go without an eye test because he cannot afford it.

We shall plug the biggest gap in the Government's list of health targets by introducing targets to reduce inequalities in health between income levels. Conservatives cannot do that, because they have spent a decade levering open inequalities in income and cannot now admit that they have also widened inequalities in health. We can improve matters, because we understand that people who are poor will suffer from poor health. We know that, when people are unemployed and cannot afford decent food, their children will grow up stunted; that, if pensioners cannot afford to heat their homes, they are more likely to die in winter.

We recognise poverty as a health issue, which is one of the reasons for our intention to end poverty wages through a minimum wage. We cannot stomach the double standards of an Administration who tell us that £3.40 is not too much for a prescription charge but is far too much to ask as a minimum wage for an hour's work. We shall do these things because we believe in policies that would enable us to live in a society that would rather invest in a modern health service than take tax cuts and run.

People outside also want to live in that society. They want the health policies that recognise that we can get better protection for everybody if we all work together to build a public health service that defends everybody rather than one that tries to protect private individuals. That is why health is now one of the largest of the major issues registered in all the opinion polls. It is also why health is now the largest single reason why people are so anxious to sweep this Government out of the way.

6.6 pm

Sir Norman Fowler (Sutton Coldfield)

At the start of his speech, the hon. Member for Livingston (Mr. Cook) dealt with waiting lists and patient care. I agree that those issues are the test, but he should remember what happened when Labour was in power and was able to implement some of its policies. Under Labour, nurses' pay did not increase, it fell behind. The hon. Gentleman spoke about rebuilding the national health service, but when Labour was in government capital spending fell by 29 per cent. Spending on hospitals has never been cut as it was by the last Labour Government, who left the hospital building programme in total chaos.

People will have no confidence whatever in the speech by the hon. Member for Livingston, because it amounted simply to generalisations and at no stage did he set out how much he intended to spend on the health service. Over the past 15 years, the actions that caused most harm to health care had nothing to do with trust hospitals, contracting out or health charges. They were the industrial action that brought the 1979 winter of discontent and the health strike of 1982. That action lengthened the waiting lists and prevented patients from being treated. In 1979, the Labour Government did nothing to prevent the damage and in 1982 Labour supported the industrial

Mr. Harry Ewing (Falkirk, East)

As a former Secretary of State, the right hon. Gentleman knows that the hospital building programme is a long-term project. When the Labour Government came to power in 1974, I found, as Health Minister at the Scottish Office, that there was no hospital building programme to inherit from the outgoing Tory Government. It took us some time to get into place a decent hospital building programme.

Sir Norman Fowler

I have great respect for the hon. Gentleman, but I do not accept that as the historical position. It is well set out in every objective history of that period that the Labour Government got into such devastating trouble with their economic policies that they had to cut every capital building programme, including that for hospitals. That is why the Labour Government were so disastrous for social services.

If predictions are required, mine is that the greatest danger for the future of health care—that is, services for the patient—is a Labour Government who are still in hock to the big public service unions. We have already seen the process in operation. Mr. Bickerstaffe has told Labour Front-Bench spokesmen that his members do not want any contracting out or competitive tendering. Without any discussion or argument, the hon. Member for Livingston has given an assurance on that to the unions. He would throw away, if he were in government, £50 million of income to the NHS.

There is no point in talking about underfunding of the health service when a shadow Secretary of State is prepared to agree to such demands. Those who are interested in health care should be concerned about that position because there is no point in giving the health service extra resources if those resources, rather than being devoted to patient care, are used to buy union support. Mr. Bickerstaffe clearly regards Labour Front-Bench spokesmen as soft touches, as pushovers.

The hon. Member for Livingston once again raised the issue of privatisation, but, in an effective speech, my right hon. Friend the Secretary of State thoroughly and ably demolished those claims. This is not the first time that the privatisation issue has been raised. It was raised in the 1979, 1983 and 1987 elections. Not long before the 1983 election, I published a short document, called "Co-operation between the NHS and the private sector at district level", aimed at achieving sensible co-operation, for the benefit of patients, between the health service and the private sector.

I am glad to see the right hon. Member for Blaenau Gwent (Mr. Foot) here because, as Leader of the Opposition at the time, he described this as the most serious attack on the national health service since it was started. I am glad also to see the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) here. She said that we were secretly dismantling the health service.

Those statements sum up the attitude that the Labour party has displayed on health service policies over the past decade. It is not interested in any co-operation between the health service, the private sector and the voluntary sector. All we have is this sterile, barren knocking match between the two sides.

The privatisation claim should be seen for what it is. It has no substance. It is but an electoral card. The only difference is that this time the card is being played even before the election campaign has started. It has achieved the unlikely result of making the hon. Member for Oldham, West (Mr. Meacher) appear to be a master strategist. However, my right hon. Friend the Secretary of State is correct. The Labour party has already abandoned its central claim of privatisation, which must mean the organisation on the health service on private insurance lines.

The Labour party has a new claim—that of creeping privatisation—the basis of which must be a policy of national health charges. That is a curious accusation, because it was not a Conservative Government who introduced prescription charges, eye test charges and dental charges, but a Labour Government. One could construct a theory that Mr. Attlee and Mr. Gaitskell stand revealed as closet privatisers, but it is much more likely that the first post-war Labour Government faced the problem that has characterised the health service ever since —an increase in costs led by an increase in demand and therefore a need not only to raise resources but to use those resources to maximum effect for the benefit of patients.

Mr. Robert Litherland (Manchester, Central)

Will the right hon. Gentleman give way?

Sir Norman Fowler

No, I shall not, because I do not wish to take up much time.

That is why so much of the Opposition case today and so much of the case that they set out in the country is so barren. There is no doubt that over the next year, the cost of the health service will increase because of an aging population and medical advances. Thus, the aim of the Government, of whatever political complexion, must be to achieve, through good management of the service, the maximum impact on health care.

Mr. Robin Corbett (Birmingham, Erdington)

Will the right hon. Gentleman give way?

Sir Norman Fowler

I have already said that I shall not give way.

What trust hospitals are all about is devolution downwards. It is what any decently run company or corporation would do. I speak with at least some experience when I say that it cannot make any sense for all the decisions in a service of about 1 million people to be made by the Secretary of State at the centre. If Labour Front-Bench spokesmen do not understand that, they understand nothing about the NHS.

The Opposition oppose this policy, as they have opposed other changes. After the report from Roy Griffiths, I introduced general managers, to which they were opposed, despite the fact that there was no mechanism for making effective decisions. Today, they accept general managers and will not abolish them, despite two years opposing such a policy.

I remember that they opposed the selected list of drugs. As many of my hon. Friends will remember, they pressed me to make economies in the drugs budget, but when I tried to do so, they showed their great constructiveness by opposing my measures. If they ever come to government, they will not reverse that policy. Not even the hon. Member for Peckham (Ms. Harman) would put all those drugs back on prescription.

The Opposition have a great deal to be modest about in respect of their record in opposition. They have now announced their blanket opposition to competitive tendering in ancillary services such as catering and cleaning. There is no question but that that throws away resources, but the principle is that it is often more effective for a specialist company rather than an in-house organisation to do work such as catering and cleaning. There is nothing especially revolutionary about that—it is not even a matter of the public sector versus the private sector. Managers in all types of organisations have the option—sometimes they use it and sometimes they do not.

If the Labour party were in power, that option would be abolished, and that shows a good deal about the party. It shows what I can describe only as an antipathy towards outside industry, an antipathy which shifts only when the Labour party puts down a motion that deplores or regrets the decline in industry itself. However, above all, it shows an antipathy to good and effective management inside the health service, and that is what I regret most profoundly. Labour has no experience of management. That is not necessarily a criticism, but it is a criticism when I say that Labour shows no interest in good management.

The Government are right to aim for a better-managed health service and one in which the patients' interests are dominant rather than the interests of the providers. Labour's approach may scare some voters—I accept that it could easily do so—and I suppose it is possible that its approach may win a few votes. Personally, I should rather lose a few votes and do what I believe is right in this respect. In fact, I do not believe that the Government will lose votes on their health policy, because the Opposition have started their scare far too early. They are already being rumbled, as my right hon. Friend the Secretary of State showed in his brilliant speech, and by the last act, they will be revealed as bankrupt of policies. Basically, they stand for nothing but the interests of the big public service unions. We respect the legitimate interests of all those who work in the health service, but, above all, we stand for better patient care. I believe that we have the courage to pursue policies that will achieve better public health care.

6.22 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye)

The debate on the future of the health service—especially that between the Secretary of State and his opposite number in the Labour party, the hon. Member for Livingston (Mr. Cook)—has become or has begun to resemble a cross between All Souls college and the All Saints road. This afternoon's debate is scarcely an exception. Somewhere in the middle of the claims and the counter-claims, of the inflated and exaggerated allegations from both parties, is the national health service. It is undoubtedly true that it is underfunded, that it suffers from low staff morale, that it is increasingly becoming a political football and that, on the basis of this afternoon's evidence, it is likely to remain so.

The Select Committee on Health could serve as a useful barometer. On occasions, despite its all-party nature, it has been able—as the right hon. Member for Sutton Coldfield (Sir N. Fowler) and the present Secretary of State surely know—to produce unanimous reports on many conten-tious, difficult and complex health issues. Sadly, that ability appears to be lacking in the Chamber, and the Government's reforms continue apace. That must partly be due to the way in which the Government went about their reforms.

Had the previous Prime Minister bowed out the leadership of the Conservative party after, say, a decade in office, one doubts that the reforms would have been introduced in the way that they have been, that the pace would have been accelerated as it has been or that they would have seen the light of day in their current form. I cannot envisage the current Prime Minister or the Secretary of State going about the reforms in the way that they are now obliged to do. They are living out the legacy left to them late in a Parliament and very late in the day for the Government.

When one considers that legacy and the about-turn in one aspect of policy which the Secretary of State mentioned on television yesterday—in respect of tax incentives foisted on the Cabinet and contained in the Budget two years ago against the wishes of the then Secretary of State for Health, the Chancellor and many others—one must ask, in view of the number of people in general management who are now on performance-related contracts in the health service, what return a Secretary of State and his Cabinet colleagues would enjoy in terms of performance-related ability for such about-turns in respect of the public purse within only 24 calendar months.

The Government decided to press ahead with the first tranche of trusts despite all the warnings. Last week, we heard about the second tranche of trusts despite the lack of democracy, the lack of consultation and the lack of public and professional consent. Mao Tse-tung was once asked what he thought of the French revolution. He sat back for a moment and then said, "It is too early to say." The same cannot be said about the NHS trusts. It is by no means too early to come to a conclusion about them. In the absence of pilot schemes the trusts have been a crazy way of going about reforms. The national health service—

Sir Jim Spicer (Dorset, West)

Will the hon. Gentleman give way?

Mr. Kennedy

Of course I shall give way to the hon. Gentleman in a moment.

Earlier this year, before we moved into the second wave of trusts and before the first wave had begun to hit serious problems, the Secretary of State made it categorically clear in the House and outside that in future Ministers would no longer have to take key decisions in the way they did at that time about which hospitals would go and which would stay. If hospitals were inefficient, if there was over-provision or if they could not provide the right type of care or treatment, they would wither on the vine under the new commercial internal market system.

But what did the Secretary of State say last week when phase two of the internal market system was announced? His statement contradicted the philosophy behind the Government's approach. Announcing the delay until April 1993 of the date on which the four London teaching hospitals would become operational trusts, he said: I have asked the NHS management executive to establish devolved management in these hospitals at the same time as the other trust boards are established. In this way, these four great hospitals will get as early as possible the benefits of devolved management."—[Official Report, 16 October 1991; Vol. 196, c.312.] We would not be against the benefits of devolved management. It makes sense to suggest that public money can be used more efficiently nearer the point where the care must be delivered. That points to greater devolution within the hospital sector of the health service, but the Secretary of State's statement contradicted the thinking behind the reforms. It makes it clear that one can have the devolved management structure without having to go the whole way towards NHS trust status. The Secretary of State admitted that contradiction in his concession last week.

Sir Jim Spicer

The main thrust of what the hon. Gentleman is saying is that we need to establish a track record on the trusts. I come from West Dorset, where three trusts have been established. We are side by side with the Yeovil district hospital, which is a trust. The hon. Gentleman talks about low staff morale, but in the five months since that trust has been established, staff morale is sky high and its record of achievement—alongside that of West Dorset —is remarkable. Perhaps he has discussed the issue with the leader of his party, but would it not be more politic for the leader to say that he has a good example on his own doorstep and that he would be wholly in favour of the policy if the same progress could be established as is seen in Yeovil hospital?

Mr. Kennedy

That is not the account that I received from the leader of my party. On his recent visit to that hospital he was concerned, as the local Member of Parliament, about the anxieties expressed to him by people in the hospital about the future funding basis. They were precisely the anxieties that have arisen about so many other trusts because of the uncertainty into which they are entering.

The hon. Member for Dorset, West (Sir J. Spicer) will appreciate that I am not in a position to bandy statistics with him about his part of the country, and I suspect that he does not want to give an in-depth account of health service provision on the north end of Skye. I will say to the hon. Gentleman that any step into the unknown, which for so many units—different sector hospitals in particular— trust status involves, is bound to bring with it apprehension, which my right hon. Friend the Member for Yeovil (Mr. Ashdown) has reported to me. However, I shall draw the hon. Gentleman's remarks to the attention of my right hon. Friend, and I am sure that he will be interested in what the hon. Gentleman has to say.

The hon. Member for Dorset, West has raised an important point. Surely it makes more sense, if one is to deliver more devolved management and more efficient use of public money within the hospital sector, to be more decentralist in one's approach to the management of the health service. By definition, in going down the hospital trust route, which they claim in part is about decentralisation and greater local autonomy, the Government do not follow the logic of the argument.

Local people are not enjoying a local say either in the decisions about trusts or in their subsequent operation. That has been seen over the past decade in the way in which health authority membership has been twisted again and again by the Government so that the prime qualification has become not knowledge of the health service or commitment to the area in which the health care is delivered, but first and most importantly: "Is this individual a card-carrying member of the Conservative party?" That makes people cynical about the changes they now see.

The cynicism has been heightened with the trusts because all too often the board, the company and the directors established and appointed do not have a tremendous—or any, in some cases—track record of experience of the health service, and do not have a local community identification in the area in which the trust will operate.

The Secretary of State announced last week, in the absence of any pilot scheme and now with only one specific, important and necessary independent inquiry into the health service in London, that he is pushing ahead. Why, if he can freeze the four teaching hospital applications, can he not apply the same principle further afield and freeze the second wave of trust applications? Indeed, he could go further and cancel them, and extend the London inquiry to a national basis. In the meantime, he should not pursue further any opt-outs in Scotland or in Wales.

Looking at the memoirs of the right hon. Member for Worcester (Mr. Walker), the former Secretary of State for Wales, it was interesting to see his account of the time when trust status was first being discussed within the ranks of the Cabinet. He was allowed by the then Prime Minister, as he interestingly reveals in the memoirs, to treat Wales as a laboratory for his far more Keynesian approach to politics generally, rather than for the Thatcherite economics which was the order of the day. He concluded simply that NHS trust status would not be a relevant factor for Welsh health care delivery. That was not so in Scotland.

In the context of the all-important Kincardine and Deeside by-election, we have what the Minister of State, Scottish Office wants to hold up as the flagship NHS trust application for Scotland—the Foresterhill complex in Aberdeen. That flagship is more likely to prove an electoral Titanic for the Scottish Conservative party. In the context of the Grampian area and of Aberdeen in particular, there is no scope for any meaningful competition for Foresterhill.

The Foresterhill application effectively involves the confiscation of land from the university of Aberdeen, which has joint ownership of the site. If the hospital were to pay the university at the market rate, it would saddle the

trust with so much capital debt that it would render the business plan meaningless, and the trust would be bankrupt even before it had been set up. Perhaps the Secretary of State will compensate the university for the loss of the site. However, that would be a blatant misuse of public funds for politically doctrinaire ends.

It would be utterly absurd for the same person to decide what level of compensation the university would receive for the loss of facilities, if the trust application went ahead, and to sit in judgment on the trust application itself. It would be a classic conflict of interest. It would not be allowed in the council chamber, and it should not be allowed in the Cabinet. That alone should render the entire application for the Foresterhill opt-out null and void forthwith. If the Government are not willing to give that message at the end of the debate tonight, they will get that message from the public in the by-election on 7 November.

What about the existing trusts which have already gone ahead in England? They should be reviewed case by case, given the remarkable financial holes which have opened up among many of them. Their financial viability, the community responsiveness and the extent to which they can be brought back under the health authority's ambit should all be guiding principles here. The membership of the trusts, and the whole question of the extent to which the buildings and the sites involved can be brought back directly into NHS public ownership, are also relevant.

It is not enough to look at the existing tranche of trusts, as the Labour party proposes to do, and to say that, on the appointed hour, all the gears will be thrown into reverse and there will be a further reorganisation in the other direction. I can assure the House that anyone talking to professionals in the health service knows that they are sickened by reorganisation after reorganisation, and that morale would be further depressed by that. A more pragmatic approach will have to be taken to the first wave of trusts.

Mr. Robert Hughes (Aberdeen, North)

The hon. Gentleman is on an interesting point, especially in relation to the Foresterhill hospitals. Is he saying that, if the Secretary of State for Scotland agrees to the opting out of Foresterhill, matters should be left there, and that the health of the people in my constituency should be left to the vagaries of the trust? The hon. Gentleman cannot have it both ways. He is either for the trusts or against them. He cannot hedge any more in Kincardine and Deeside.

Mr. Kennedy

There is no hedging going on in Kincardine and Deeside, or anywhere else, as the hon. Gentleman knows. The Liberal Democrat candidate in Kincardine and Deeside has organised a massive petition for many months before the by-election on the issue. I have just made the position clear. In Wales and in Scotland, there should be no opt-outs, full stop, because they are not there already. In England, there should be a complete cancellation of the second wave of proposed opt-outs.

For the first wave opt-outs which have already gone ahead, the presupposition must be against the continuance of NHS trusts, which means studying the membership of the trusts and the statutes under which the trusts have been established, including the ownership of the sites and of the land, the conditions of service of the staff, the contracts of employment and the lack of democracy that has bedeviled the entire process, to ensure that the national erosion of the health service does not go further. That is a clear and unequivocal statement of position.

Mr. Jim Sillars (Glasgow, Govan)

Let us consider the position in Scotland. If the Tory Government ignore public opinion in Kincardine and Deeside and, let us say, in Ayr, where the Ayr district general hospital is also a candidate for trust status, will the Liberal democrats wish those hospitals not to be transferred back into the national health service?

Mr. Kennedy

No.

Mr. Sillars

The hon. Gentleman says no. Why should it be different in England?

Mr. Kennedy

With great respect to the hon. Member for Glasgow, Govan (Mr. Sillars), I must point out that I have said no such thing. The smile on the hon. Gentleman's face suggests that he knows that. I have made the position clear. In Committee and in the House, the Liberal Democrats opposed NHS trust status, and we continue to do so. I am talking about the first wave that have been approved in England. They are already up and running. The question that has to be addressed is how, in practical terms, they can be brought back under proper national health service management control. Practical legislative means are available to the Department of Health, and we argue that such means should be used. That position is clear.

Mr. Bob Cryer (Bradford, South)

rose—

Mr. Kennedy

I want to continue.

The great financial difficulty into which the Government have got themselves into is that they have confused cross-boundary flows with an internal market. That has now been seen by the health authorities that are losing in terms of extra-contractual referrals. Indeed, halfway through the financial year, some health authorities find that the money that was set aside for extra-contractual referrals has been almost used up. So much for money following the patient; the patient is now following the money, due to the nature of the block contracts which have been entered into. They reduce GP and patient choice, and make nonsense of the so-called citizens charter—let alone any patients charter.

What, then, should be done about NHS funding? First, the Government have never properly recognised that the true level of health service inflation runs persistently higher than that expressed by the retail price index. The opinions of experts differ, but I think that it is fair to say that the difference is between 1 per cent. and 2 per cent.

That being the case, surely it is essential for the Government to increase annual expenditure on the health service by a minimum of 1 per cent., in real terms, above the level of health service inflation. If they are committed to growth in the service, that will be necessary not only to keep pace with developments in medical technology and with the demographic change that has increased the proportion of elderly people, but to advance.

Secondly, within that total the Government must include the abolition of charges for eye and dental tests. There is no doubt that, in the long term, the disincentive that those charges produce will cost the country more. People will choose not to use the excellent preventive services that are now available.

Mr. James Couchman (Gillingham)

Is the hon. Gentleman aware that the number of eye tests currently being carried out has risen almost to pre-charge level?

Mr. Kennedy

I am afraid that the hon. Gentleman is very badly informed. An analysis that we have conducted over the past 12 months, which covered several hundred constituencies, proved conclusively that, in the case of opticians, the opposite is the case.

Any dentist or optician will tell the hon. Gentleman that there are now two income categories that they can treat, providing the full range of preventive and promotional health services that they wish to provide. The first category comprises people on income support, whose treatment has been fully funded; the second comprises those who are sufficiently well off not to have to worry about the cost. Those who fall between the two categories —who now form the majority—are having to cut corners, and are not proceeding with the full-scale preventive treatment that is considered essential. The hon. Member for Gillingham (Mr. Couchman) is, quite simply, wrong.

The Labour party says—I do not doubt the sincerity of its intent—that it would make extra finance available as economic growth was achieved. We should, I think, view the position with a little more optimism: we should take the view that, in the event of 1 per cent. real growth on top of health service inflation, any economic growth on the basis of which further NHS funds could be provided should be seen as a health dividend—as a means of bringing Britain, bit by bit, more into line with our continental neighbours in terms of the proportion of GDP that we devote to health.

Mr. Rowe

Will the hon. Gentleman give way?

Mr. Kennedy

In fairness to Conservative Members, I want to finish my speech soon.

Thirdly, the Government must be prepared, if necessary, to use contingency reserves for the full funding of national pay awards. We must end the ludicrous and unfair system whereby awards that are decided centrally are not funded nationally, necessitating the making of local cuts. Our approach is honest, in that it recognises the need for those who criticise the Government for not spending enough to spell out the details of the additional expenditure that they themselves advocate. I sympathise with some Conservative Members, who must feel irritated when they hear complaints from Opposition Members who give no pledges or figures to back up those complaints. That is not the stance that we have taken; we have already made our costing public.

Trusts currently dominate the health debate, and I noticed that the word "trust" also dominated the conference address of the Conservative party chairman, who almost invoked Baldwin by saying, "Trust the people." The people do not trust the Government with the health service, and they certainly do not trust what the Government are telling them about the health service and hospital trusts.

The result of the Eastbourne by-election contributed somewhat, I believe, to the atmosphere that led to the downfall of the right hon. Member for Finchley (Mrs. Thatcher); the Ribble Valley result contributed somewhat to the circumstances that led to the withdrawal of the poll tax. I think that an appropriate result in the Kincardine and Deeside by-election—appropriate from our point of view, and that of the health service—could contribute to an end to further opt-outs, and a reversal of the policy itself.

The Government's reforms are as misconceived as the present Secretary of State for Health is miscast. There is a case for a realistic costed alternative; the Liberal Democrats will continue to argue in favour of it in the House, on the hustings and whenever the opportunity provides itself.

6.46 pm

Mr. Michael Morris (Northampton, South)

First, I declare an interest: I am married to a general practitioner, and I am an adviser to two pharmaceutical companies.

This evening marks the first occasion on which I shall have voted with the Government on the national health service issue since the introduction of the GP contracts and the NHS reforms. I shall be doing so because it is now clear to me that the present Prime Minister is 110 per cent. committed to the national health service. He has made it abundantly plain to the nation not only that he believes in the service, but that he has used it throughout his life, and that his children were born into it. That commitment represents a gold standard that the public should understand and respect, and I think that they do.

My right hon. Friend the Secretary of State has shown doggedness and tenacity in achieving a real increase in funds for the national health service. That is long overdue, and I pay tribute to him. Those of us who were here at the time of the 1974 Labour Government remember all too clearly the cuts that were made then; perhaps the hon. Member for Livingston (Mr. Cook) was not here, but if he was, he must remember the debates that took place—I spoke in some of them. In particular, he must remember the 3 per cent. cut in nurses' pay, the 17 per cent. cut in doctors' pay and the 29 per cent. cut in capital expenditure on hospitals. I must tell the hon. Gentleman that that record does not stand up against the record achieved by the current Secretary of State.

Having conferred those words of praise on Ministers, I do not wish them to think that I am entirely satisfied with what is happening on the ground. I want to ask them some questions. First, are they really doing enough to chase the NHS executive up hill and down dale to implement the reforms? Let us look briefly at the role of the GPs as gatekeepers for a successful hospital service.

There is little doubt that the concept of fund holding —the concept, in effect, of the self-employed general practitioner—is attractive, and GPs will wish to continue in that role. Having read the medical press and listened to the views of many doctors all over the country, I am convinced that there is a general desire to adopt such arrangements. I hope that the artificial restriction in respect of the number of patients will be removed. There are GPs in my constituency who are under that level, but they are perfectly capable of becoming fund-holders if they so wish, although there is no compulsion.

Morale remains too low among our GPs. A letter about GPs' pay arrived this morning from the general medical services committee. It stated that targets have been achieved under the contract, but that it is the review body's desire to claw back the extra remuneration achieved by meeting those targets. If my right hon. Friend the Secretary of State wants to switch off every GP in the country, there is no surer way to do that than to ensure that, if a GP meets his target, the extra money that he earns will be clawed back for achieving the target.

My hon. Friend the Under-Secretary of State for Health issued an excellent press release on 18 October about the increase in the number of GPs using computers. That was a good press release, but it would carry more weight if there were not family health service authorities around the country which were unaware of their budget until this year was five months on and which have said that there will be no remuneration for maintenance payments. Even today, funds available for GP computerisation are inadequate to meet the targets that my hon. Friend the Under-Secretary of State wishes to achieve.

One of the problems is how to tackle the FHSAs. We must stop some of the nonsense that is occurring. The exceptional FHSAs, which do something other than the norm, cause the trouble. In some cases, authorities will transfer resources from one budget to another, and that distorts general practice in that area. In other cases, money set aside for staff and premises is transhipped to another category of expenditure. There are GPs in some parts of the country—thankfully, not in my constituency—who are not being paid the full amount for what they achieved in the previous quarter. If my right hon. Friend the Secretary of State reflects on the GP contract, he must realise that it was probably a mistake to have only one medical representative or doctor on FHSAs. The experience of those dedicated people is necessary to make the system run smoothly.

Trust hospitals are, and always were, part of the national health service. They are part of devolved management, which was the concept behind trust status. The problem, as many of us who have studied these matters know, is that the strategy of my right hon. Friend's predecessor, the former Secretary of State for Health, to rush in with 57 new trusts without clear monitoring has proved to be a sticking point.

I agree with the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) that it makes no sense to proceed without a thorough analysis of what those 57 hospitals have achieved. If the vast majority are a success, we can go forward with total confidence. I believe that that may be the case, but I should like it confirmed.

With regard to the second wave, I considered the applications for the Oxford region, part of which I represent, and I was happy to support the majority of those applications. However, I thought that the submission by the Milton Keynes acute hospital was distinctly thin. That unit has not managed to live within its budget since it was created and it has been feather-bedded because it is a brand new city hospital for the new town of Milton Keynes. Nevertheless, its application was approved. Decisions of that kind cause difficulties.

Northampton general hospital has not sought trust status yet, but what safeguards will apply to that hospital if the hospital in Milton Keynes faces difficulties? Will Milton Keynes once again receive the extra resources to the detriment of the remaining hospitals in the Oxford region? If devolved management is the basis of the development of the hospital side of the NHS, we should remember that there are two forms of devolved management in education—grant-maintained status and local management status. Although trust status may be one form of devolved management in the health service, one hopes that there may also be others—this should not be a black or white issue.

I fervently believe that it the right of every patient—and, through the patient, the GP—to know how long he or she will have to wait. I congratulate my right hon. Friend the Secretary of State on setting firm targets, so that, by next March, no one will be on a waiting list for more than two years, and that, by March 1993, no one will be on a waiting list for more than one year. Both those targets are praiseworthy. However, it is not sufficient simply to consider in-patient waiting lists; we must also consider the delays in obtaining out-patient appointments. We must highlight that dimension as well.

The changes will not occur simply as a result of exhortations from the chief executive of the NHS. There must be a combination of relentless pressure for continuous quality improvement similar to that achieved by the quality control methodology of manufacturing industry. It also requires extra targeted resources. Why can we not have a monthly statement to show what we are achieving in comparison with our targets? All hon. Members receive a monthly statement about unemploy-ment which is broken down to constituency and ward levels. If we can have such a service from one section of the state, why can we not have such information about the NHS?

The basic position of my right hon. Friend the Prime Minister is crystal clear. Whatever may have been the intentions of my right hon. Friend the Member for Finchley (Mrs. Thatcher), it is clear that the present—and, I believe, the future—Prime Minister uses the NHS; he believes in it, and he is grateful for what it has done for him and his family. The basic concept of its being free at the point of use is fundamental to him, to me and to all Conservatives. The other significant change is that my right hon. Friend the Prime Minister recognises that the NHS requires extra real resources. However efficient the management may be—there is still a long way to go in that respect—we cannot hide the fact that the NHS's percentage of GNP must rise in this country. We should not be on a level with Greece and far below France, Germany, Italy and our other European partners in that regard. My right hon. Friend the Prime Minister recognises that.

Labour never got the economy moving. Labour Members have never been able to achieve what they wanted in their hearts to achieve. Their desires remained desires and aspirations, never becoming a reality.

I remain critical of what is happening on the ground and of the way in which some of the strategies are interpreted at district health authority and FHSA level, but for the first time I can honestly say that we have a Prime Minister and a Secretary of State for Health who believe in a national health service. I shall therefore have pleasure in supporting the Government today.

Several Hon. Members

rose—

Mr. Deputy Speaker (Sir Paul Dean)

I remind the House that the 10-minute limit on speeches operates from 7 pm.

6.59 pm

Mr. Michael Foot (Blaenau Gwent)

I am the only Member who was present in the House to hear Aneurin Bevan make his Second Reading speech which introduced the national health service and also heard him, from the same Bench on which the hon. Member for Northampton, South (Mr. Morris) sits, deliver his resignation speech about charges that were imposed. I was hoping to have discussed some of that history, especially because the Secretary of State gave a most misleading account of it. He should not have done that. He should have taken a bit more notice. He might even have learnt something from a letter which appeared in The Independent the other day, which states: Sir: I am absolutely thrilled by William Waldegrave's undertaking for a complete reversal of Conservative policy on the NHS, that is, 'equal access to free health care throughout the country for everybody, regardless of their means'. My last two sessions of 'free' health care cost £52 (teeth) and £176 (eyes). Aneurin Bevan would have been especially interested in that letter. It was on precisely the charges that were introduced for teeth and spectacles that he resigned. He had some other excellent reasons for his resignation, but he tried to give a warning to the country, a warning to the Labour party, which was on the Government side of the House at that time, and a warning to some others, too. The whole country would have been wise to listen to what he said. He said: The Chancellor of the Exchequer in this year's Budget proposes to reduce the Health expenditure by £13 millon— only £13 million out of £4,000 million. He went on to state: hat is to be squeezed out next year? Is it the upper half? When that has been squeezed out and the same principle holds good, what do you squeeze out the year after? Prescriptions? Hospital charges? Where do you stop? I have been accused of having agreed to a charge on prescriptions. That shows the danger of compromise. Because if it is pleaded against me that I agreed to the modification of the Health Service, then what will be pleaded against my right hon. Friends next year, and indeed what answer will they have if the vandals opposite come in? He was referring to the Opposition. He went on to state: What answer? The Health Service will be like Lavinia —all the limbs cut off and eventually her tongue cut out, too." —[Official Report, 23 April 1951, Vol. 487, c. 41–42.] Many of us think that Aneurin Bevan had great prescience. I do not think that he foresaw the way in which the present Government would seek to impair the rights of people in the health service to raise their voices against the methods that were forced on them by the Government. He made a careful prophecy, and I hope that everyone will take account of it. The Secretary of State was wrong in his history of the subject, so I advise him to read the excellent history of the national health service by Charles Webster. Many of the problems that the health service had to face are set out.

The Times Literary Supplementreview of that publication states: The miracle of the British National Health Service is not that it survived its delicate infancy but that it ever came to be horn. Then comes the prophecy: If it required a politician with the weight of an Aneurin Bevan to create the NHS, it will probably require one in the mould of Margaret Thatcher to dismember it. The word "dismember" may be just as good as "privatise" because it means pretty well the same thing. It means exactly what my right hon. Friend the Leader of the Opposition and my party have been describing to the country that the Government seek to do.

We can review the history of this measure as well as the history of what happened in the days of the Labour Government and the way in which we introduced the national health service and fought for it against all the opposition raised from Conservatives all over the country. There has been a history of this measure. The hon. Member for Northampton, South has made many brave speeches criticising the Government on the subject of the health service. He has much more knowledge of the health service than most of the rest of his party rolled together. They should take note of what he says. On previous occasions he has been even more critical. He now says, "It is different. The policy that is now being pursued by the new Prime Minister is different from the one that was introduced by my right hon. Friend the Member for Finchley (Mrs. Thatcher) when she was Prime Minister."

We must be fair to the right hon. Member for Finchley. It may seem very strange for an Opposition Member to say that, but we should be fair even to her. She was responsible for the introduction of the measure. She was responsible for refusing to listen to the doctors, the British Medical Association and the royal colleges. She is the one who slammed the door in their faces and would not listen to them. It is most unfair that all the blame should be put upon her. She was much too impatient, but she had Ministers who were much too subservient. She was always hectoring and they were always cringing. She knew what she wanted to achieve; they knew they wanted to hang on to their jobs.

If anybody questions what I say, he or she has only to imagine what would have happened if any Secretary of State for Health—heaven knows, there are plenty of former Secretaries of State for Health on the Government side of the House—had dared to have the latter-day conversion which afflicted the right hon. Member for Henley (Mr. Heseltine). He belatedly decided that he would oppose the poll tax, even though he was quite prepared for the poor Scots to endure it. But he at least revolted. If one Secretary of State or one member of the Cabinet had dared to revolt, the Government would not have led us down that dangerous path which threatened the future of the national health service.

Ever since the new Prime Minister took his job—an Edmund Burke phrase rings in my mind—his Ministers have attempted meanly to sneak out of difficulties into which once they proudly strutted. Pretty well all of them strutted in. A couple of years ago, even the hon. Member for Northampton, South was an enthusiastic supporter throughout the country. He gave almost as much support to the proposals then as his right hon. Friend is giving to the present proposals. We see no great difference between them. Anyone who studies the reality will see that they are very much the same proposals—the same proposals which the right hon. Lady forced on her subservient Cabinet and the same proposals which they devised in the Cabinet committee that had never examined any of the proposals and objectives from the medical profession or the British Medical Association, as the hon. Gentleman will be keen to confirm. Even more serious is the fact that the heads of the royal colleges pleaded with the Government, the right hon. Lady and her subservient Ministers to listen. We could have been saved all that trouble.

Five months, 10 months or two years ago, huge sums of money could have been saved. I am not sure whether we would have saved more than the losses on the poll tax— that would certainly mean setting it pretty high. As my hon. Friends have often said, we could have had a united, intelligent review of the health service.

Aneurin Bevan was never opposed to reviews of the health service. He even said that they should happen every five or 10 years to see how we should make the best advances and how we could make the whole apparatus more democratic. Indeed, he set out the measures to do that. In 1958, in his last speech on the health service, he told the Conservative Government, "You have had about five or six Ministers of Health. They have not been much good because, apart from their other disqualifications, they have been here such a short time that they are unable even to learn their job, and the main point of their job is how to stand up to the importunities of the Treasury." That was the delicate way in which he described it.

When we win the next election, as I am sure we shall, I hope that my hon. Friend the Member for Livingston (Mr. Cook) will be given the same five-year period at the Ministry of Health as was given to Aneurin Bevan in 1945. When he was given the chance, Bevan said, "I want to stay here for five years to carry through the whole programme." One of our very best days since 1948, when the NHS provisions were introduced, will be when my hon. Friend the Member for Livingston, who has earned so much respect because of the way in which he has put his case, takes up the office of Secretary of State for Health and starts to clear up the terrible mess that the Conservative Government have made.

7.9 pm

Sir Timothy Raison (Aylesbury)

I am one of those who enjoys listening to the right hon. Member for Blaenau Gwent (Mr. Foot) speaking as Aneurin Bevan's vicar on earth. It will be a sad day when we can no longer hear him speak in the House. Unusually for him, when the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) spoke on behalf of the Liberal Democrats, he used a tired phrase; he talked about health being treated as "a political football". I think that we all know in our hearts that that will continue and that there is absolutely no possibility of the House of Commons ceasing to take an interest in health or of its ceasing to do so in a thoroughly partisan way. Indeed, it is right that we should debate the health service in the Chamber and even inject party politics into the subject.

Having said that, however, we are reaching a situation when the Labour party's posture on this matter—and especially that of its Front-Bench spokesmen—is becoming more and more ludicrous. The scale and nature of Opposition Members' attacks on the health service are totally misleading and mendacious. Their case is becoming absurd and beginning to fall apart.

We all heard the hon. Member for Livingston (Mr. Cook) once again trailing out a list of touching hard cases. The public are beginning to see through all that. It is time that the hon. Gentleman looked for something else to talk about. I notice that he is about to leave the Chamber, and I do not blame him for that. He talks a lot about long waiting lists, but the longest waiting list is the one that he is on in his search for office.

I genuinely believe that my right hon. Friend the Secretary of State has managed to reverse the gravamen of the political onslaught in the past few weeks. The way in which he has responded to Labour's irresponsible attacks and has clearly shown exactly what is happening in the health service has been enormously to his personal credit. It is beginning to get through to the public that there is something false in the Opposition's assertions.

I firmly believe that our structural changes are on the right lines. The introduction of the trusts and of budget-holding practices is a thoroughly good idea. I do not go along with those who say, "Let's sit back for a few years to consider whether they are a good idea." It would be totally wrong to block the growing impetus for reform in many parts of the country. I do not know what people in Scotland and Wales are saying—perhaps they do not want to experiment with trusts—but the blocking or deferral of the proposed trusts in my part of the country would lead to great disappointment. Anybody who has looked at what is happening or talked to the people involved will know that what I am saying is true.

I do not claim that we have always got our health service reforms right. It is pretty obvious that our reforms at the beginning of the 1970s were wrong. Although I dutifully voted for them, I now think that we introduced a grossly over-bureaucratic system in which tier was piled upon tier. That had to be dismantled. I am not trying to claim any unique virtue for my party's approach to such things, but I believe that we have now evolved a system that offers the possibility of a greater directness of management. It will be a much leaner system than in the past and one in which decisions will be taken where they should be taken. To use a naval analogy, we are trying to ensure that decisions will be taken on the bridge of the ship rather than in the Ministry of Defence. If that principle is sound in war, which it most certainly is, exactly the same should be true of running the health service.

As a result of the reforms, I believe that we shall see a more clear-cut management with incentives to efficiency through competition. It was interesting that the hon. Member for Livingston ended by saying that a Labour Government would be looking for incentives to try to increase efficiency and to reward success. Curiously, therefore, at the end of his speech he started to concede part of the philosophical argument. Of course, a Labour Government would not actually do that, whereas we have found a system that will achieve it. Indeed, until recently, socialism everywhere always led to a bureaucratic approach. The irony is that socialists elsewhere are now beginning to recognise the failures of the bureaucratic approach and are working hard at decentralisation. That is happening in the countries of eastern and central Europe —only the British Labour party is living in the past.

We all know that the health service will not be magically transformed overnight. Nobody expects that. However, given time to mature, I believe that the new system is heading in exactly the right direction. I should like to illustrate that point by examples from my constituency where the state of play is that we have four trusts or potential trusts. One has just been approved by the Secretary of State; one has been deferred; and two are included in the third wave.

The new trust that was accepted last week is the Aylesbury Vale community healthcare trust. I am sure that it will be outstandingly successful. The trust will cover adult mental health, the elderly mentally ill, mental handicap, physical rehabilitation and general community work, such as district nursing, health visiting, chiropody, and palliative care. It will come into being with strong popular support. Indeed, there was very little opposition to it at the discussion stage. Those who will operate the service are committed to it and the community health council supports it. It would be a bitter blow to say to those people, "Sit back, go away and do nothing for the next year or two." As I said, I can see no reason why that trust should not be outstandingly successful.

The trust in south Buckinghamshire, to be based around Wycombe, was deferred. Although that is sad because much good work went into its preparation, I do not necessarily blame my right hon. Friend the Secretary of State for deciding to defer it, because it would be a single-district trust and I have always had some reservations about whether such trusts are the right way of proceeding. Perhaps some financial questions remain to be resolved. I am delighted, however, that although my right hon. Friend has made it clear that he cannot accept the application at this stage, he believes that the trust will be able to go ahead in due course and he will consider its application sympathetically. If we were to have a single health authority for the whole of Buckinghamshire instead of three different health authorities, I am sure that we would overcome the single district trust problem and that such a trust would then have the viability that it does not have at the moment.

The proposed third wave for the county ambulance service seems to make good sense. The other proposed third wave trust would cover Stoke Mandeville hospital. Although it is famous for its spinal injuries unit, it is, of course, a district general hospital as well. It has had some difficult problems and some disappointments over the delay in its redevelopment programme. It has also had various other problems, including overspending. Again, I believe that the best way of tackling those problems and of making use of its highly skilled staff would be to run the hospital from within the unit rather than imposing management from outside.

I am not criticising the past management, although they have had their difficulties, but if one asks what is the best way of running a unit that faces problems, of having a happy staff, of building up their morale and of tackling some tricky development problems, who could seriously deny that that is far more likely to be achieved by managing the unit from within—rather like a battleship —than by imposing the management from outside?

I believe that the underlying philosophy behind what we are setting out to achieve is absolutely right. Of course, there will be problems. The health service will be underfunded, but then, it will always be underfunded. Anyone who is honest will accept that it will always demand more and more money. However, on the crucial question of how we can best tackle the problems, increase morale and achieve clear-cut decision making, I believe that the idea of the trusts is right. It would be a great error to be pushed off course and to delay or abandon their implementation.

7.19 pm

Mr. David Young (Bolton, South-East)

The Conservatives have always argued that the national health service is safe in their hands. In fact, it is about as safe as a chicken in the hands of a farmer who is about to wring its neck. The public support for the Labour party stems not from propaganda but from ordinary people's experience of the health service—people who are told that they have to wait for one or two years on the waiting list for an operation but that if they paid privately they could have the operation within days or weeks. That is not choice—that is extortion.

The Government have consistently argued that we have a free health service, but by extending the payment per prescription from 20p to £3.40, they seem to have flown in the face of that principle. They have certainly cancelled eye tests. They have also cancelled the dental test. The main sufferers when such tests are cancelled are the young and the old—the people most at risk whom we as a community should seek to help. If high blood pressure and glaucoma are not detected in an eye test, does that not lead once again to hospital lists being extended by people who have to go for remedial treatment, when preventive treatment would have been less costly?

During the past 12 years, we have seen the Conservatives create a two-tier health system. With 900,000 people on the waiting list, the incentive to the patient to go private is not choice but pain. The Government's policy has made the long waiting list the recruiting sergeant for private practice. A two-year waiting list may be acceptable to the Secretary of State, but when an 81-year-old woman is waiting for a hip replacement, the question which goes through her mind is, "Will the surgeon get to me before the undertaker does?" That is the choice that the party of choice provides.

Underlying the whole system is the fact that the quality of life of people on waiting lists is affected and undermined. In a civilised society, we should consider quality of life, if nothing else. The Conservative party claims to be the party of choice. What chance is there of going to the hospital of one's choice if one wants to go to a hospital to which the district health authority has not contracted out and if the extra referrals budget has gone by the board? What choice is there then?

What choice is there for the single elderly person who requires long-term nursing care if there is little or no community budget? What choice is there except a private nursing home? I am aware of what the Secretary of State for Social Security has said today about giving more money to such people, but unfortunately it is not elderly people but owners of private nursing homes who will receive the extra money. We shall soon see the charges at those private nursing homes increase once again.

However, that is not the question. What about the many people just above the benefit level and those who throughout their lives had saved for a rainy day? It will be a pouring day when they have to fork out £15,000 to £20,000 per annum for private treatment in a nursing home. What about people who are told that they have to sell their home in order to obtain treatment? Where are they when they can no longer afford that treatment? Will they be downgraded, as in America, from one nursing home to another? Is that the type of society that the Tory Government want? It is certainly the kind that they have created.

As a Member of Parliament for Bolton, I have always been concerned about the health of Bolton. No hon. Member who represents that area can be otherwise when one reads the Black report and other reports from the director of medical services which tell one about the health of Bolton. On 27 January 1981, I got the go-ahead from Sir George Young for the new Bolton general hospital. For almost a decade the Government failed to come across with the money. If the speculation in yesterday's Sunday Mirror is correct and the £37 million is to be diverted for other purposes—the article mentioned opting out and hospital trusts—that will be a gross betrayal of the people of Bolton.

Mr. Thurnham

The hon. Gentleman says that he is concerned about health in Bolton. Will he retract the bogus scare stories to which he was party about cancelled operations in the north-west? Does he accept that no health authority has said that there is any truth in it? In Bolton, there were only 651 operations not cancelled, but postponed, and 780 operations were put off because patients did not turn up for them. Is that financial cuts?

Mr. Young

I wish that the hon. Gentleman would use his own time and not mine. He will have a chance to make his speech. I have represented Bolton and I know of the cuts. One of the things that sickens the people of Bolton is this. When the right hon. Member for Finchley (Mrs. Thatcher) says, "I want the surgeon of my choice at the time of my choice," that is fair. But it is not fair that her policies have denied that to everyone else. A plasterer in my constituency has to remain idle because he has months to wait before he can have an operation on his elbow. That is what I am talking about when I complain about waiting lists.

It is no wonder that certain hon. Members become coy when they attack us on our assertions but will not declare whether they and their families depend on the national health service. That is the only criterion on which to judge whether people believe in the national health service. If they do not go into those hospitals or see the waiting lists, it is easy to argue in statistical terms, but one person on the waiting list for two years is one too many. If there had been an incentive to remove the waiting lists, it could have been done. Instead, the Government provided handouts in terms of private health insurance for the elderly, which the Secretary of State has retracted now that an election is approaching. I want a health service for all the people, not just for those who can buy their way out of the system. That is the health service that we want in Bolton and for the country—and that is why, after the next election, there will be three Labour Members of Parliament for Bolton.

7.29 pm

Sir Jim Spicer (Dorset, West)

I am delighted to follow the hon. Member for Bolton, South-East (Mr. Young). and most hon. Members owe a great deal to the national health service over many years. I certainly do in personal terms, but even more in family terms.

My eldest daughter broke a leg. She had a broken leg for eight years. During that period she had 14 major operations. The last one took thirteen and a half hours. She is now walking on that leg and is healthy. Not once did she dream of moving out of the health service, and not once did she not receive superb treatment. I am sick and tired of hon. Members who try to say that we have the worst service in the world. We have the best service in the world, and the sooner we all recognise that, the better.

I am sorry that the hon. Member for Livingston (Mr. Cook) is not here. I, too, shall return to that marvellous television programme, "On the Record", which I enjoyed enormously yesterday. In that programme, the hon. Gentleman was trying to be a good fairy—I mean that in the nice, old-fashioned sense. He was saying, in effect, "Vote for me and all will be well." As my right hon. Friend the Secretary of State made clear, the hon. Gentleman avoided some questions. First—this question will return time and again—how much additional funding does the Labour party believe to be essential for the NHS? Is it £2 billion a year, £3 billion, £4 billion, £5 billion or £6 billion? Hon. Members can ask that at various times of various Labour-Front Bench spokesmen and they will always get different answers.

My second question relates to the hon. Gentleman's speech today. How will he translate his obvious dislike of and distaste for private residential care, where so many elderly people reside with the help of the Government, into action if, unfortunately, he ever becomes the Secretary of State? Hundreds of thousands of people throughout the country would like an answer to that question.

I knew a geriatric hospital with wards of 10 or 20 beds which was to be closed. The spirit there was marvellous. I followed the case of each patient moved from that hospital. One old lady said to me, "I never thought that I would be able to live out my life in a room of my own with a view like this—I thought that I was condemned to living in a ward for the rest of my life." Is the hon. Gentleman against taking elderly people out of hospital institutions and putting them into private accommodation? The country and certainly my constituents would like to know.

The same "good fairy" gave the impression that he would wave a wand and, miraculously, the money to achieve everything would appear. He said that it would come from "the economy", but what possible growth in the economy can we rely on under a Labour Government? How many years does he expect that it will take to wipe out his theoretical underfunding? Yesterday the hon. Gentleman was coy about that, as he has been in the past. As my right hon. Friend said, the hon. Gentleman has changed his tack and stance on this time and again.

My third question is: how carefully has the hon. Gentleman researched authorities with trust status? In particular, has he looked at the West Dorset health authority, which has been fully trusted for its acute, community and mental health services since April? Perhaps he would like to visit us. If he or the hon. Member for Peckham (Ms. Harman) would like to come, we should be delighted to welcome them. They would see the resounding success achieved through wonderful co-operation between the authority, the trusts, the consultants, the doctors and all health service employees.

I will give some quick examples of what we achieved. From an annual budget this year of £77 million, we have already achieved a saving of £1.3 million, which will be devoted entirely to cutting waiting lists. Since April, 80 per cent. of patients have been treated within six months. Soon none will wait more than a year. Nobody will wait for two years, as the hon. Member for Bolton, South-East said. Even that one year wait will be exceptional. For each of the past three years, 6 per cent. more patients have been treated. There is a total commitment to the second phase of our splendid district hospital, which will combine all our acute resources on one site. Coupled with that, we have major improvements in all our community hospitals under our community trusts. On the mental health side, we have seen the closure of Harrison and Coldharbour hospitals —two marvellously run hospitals, but built 150 years ago. Their patients are now back in the community. I have seen what has been achieved even in six short months, and it is remarkable.

Will someone from the Opposition Front Bench please come and look at what is happening in west Dorset? I extend the same invitation to the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). He mentioned Yeovil hospital. That was where my daughter had most of her operations. There is no better hospital. It has trust status. The hon. Gentleman said that the right hon. Member for Yeovil (Mr. Ashdown) visited the hospital recently and discovered that some people there were unhappy or, at least, uneasy about the future. Perhaps he talked to different people, because I have spoken to some people there in the past three or four days and they are happy.

I hear that the number of patients treated in Yeovil hospital is up by 5 per cent. since April, that waiting lists are substantially down and that only 63 patients have waited for more than a year, a decrease of 70 per cent. on last year's total. The hon. Gentleman said that he was sure that there must be a fly in the ointment somewhere and that the hospital would probably run into financial difficulties. It will not. It has a balanced budget. It is appointing five new consultants, three arising directly from the trust status, and more improvements are expected across the board. I am delighted that the right hon. Member for Yeovil will gain so much in his constituency as a result of the policies instituted by the Government and I hope, although I fear that it is a forlorn hope, that he and his colleagues will vote with the Government tonight.

I have made my position clear. I depend on the NHS and always will, and so will my family. So long as we have a Conservative Government wholly committed to it under our present Prime Minister, that NHS will continue to operate at an increasing level of efficiency and with better management. As has been said, proper management of scarce resources is the key. We cannot go on always throwing more money at the NHS. We must use that money more efficiently. Surely no one can deny us the right to do that.

7.37 pm

Mr. David Hinchliffe (Wakefield)

The simple fact which neither the hon. Member for Dorset, West (Sir J. Spicer) nor any Tory Member who spoke before him has addressed is that the majority of British people believe that the Government are intent on privatising the national health service. The public are witnessing the obvious break-up of the NHS by a Government who have no electoral mandate for such action. It is the logical action of a Government who have privatised numerous state industries and who have a pathological hatred of collectivism, co-operation and of the socialism inherent in the principles of the NHS. It is the logical action of a political party that voted against the introduction of the NHS way back in the 1940s before I was born. The public are not stupid. They can see the obvious steps that have been taken in the direction of a health care market.

My right hon. Friend the Member for Blaenau Gwent (Mr. Foot) said that the Government had used certain processes in pursuing their policy and he identified one such process as destabilisation. Certainly the Government have destabilised the NHS as they deliberately decided to underfund it. According to the National Association of Health Authorities, the NHS was underfunded to the tune of £2.5 billion in the first 10 years of the Government's term of office. At the same time, however, the Government were able and prepared to give income tax concessions to people who already had plenty of money. We now see the results of that underfunding, because a quarter of all the NHS beds in Yorkshire have been closed. Not all those beds were for psychiatric or mentally handicapped patients; 15 per cent. of acute beds have been taken out of use within the Yorkshire regional health authority.

Industrial disputes in the NHS have been provoked deliberately. Those disputes included the nurses' legitimate claim for a decent working wage and the decent claim from the ambulance workers for an appropriate working wage in recognition of their expertise. The pay awards that were eventually arrived at were not funded by the Government.

The public see before their eyes that paying for health care is becoming the norm. They have witnessed the huge increase in prescription charges and the introduction of charges for eyesight and dental checks. The Government also introduced income tax concessions for private health care, the ultimate insult to a generation of elderly people who, in common with my right hon. Friend the Member for Blaenau Gwent, were around at the time the NHS was set up. Those people fought for the NHS, so is it any wonder that the Secretary of State has had to concede that that tax concession has been a shambles? Those elderly people do not believe in the concession. They share our commitment to a properly funded NHS, available to patients at the point of need.

The care of the elderly has been privatised. There are now 5,000 fewer elderly care beds in the hospital sector. In my area of Yorkshire, the number of private nursing beds has increased by 1,000 per cent. Hospital trusts, such as that in Bradford, have stated that they do not accept any responsibility for the nursing care of the elderly. They do not regard that as their job. In my constituency, NHS hospitals which were supposedly unsuitable for the care of the elderly have been closed. Sandal Grange is a classic example; it has reopened as a private nursing home. That is happening across the country.

The county hospital which previously cared for the elderly in my constituency has also been closed. We had been promised a new geriatric unit at Pinderfields hospital, but that has not come about. The old hospital has not been replaced. Snapethorpe hospital, recently rebuilt, has also been closed for the care of the elderly. Patients must now pay to go to private nursing homes to receive the care that they previously received from the NHS. Is that not equivalent to the privatisation of the NHS? Of course it is. My constituents know what is happening.

Charges have been introduced for the use of NHS facilities. Surely if people are charged to park their vehicles in hospital car parks, that is equivalent to privatisation. That is what has happened in my constituency. The people are being penalised. It is all right for Conservative Members to sneer at that, as car park charges may mean nothing to them—it is pocket money. However, for elderly people who struggle to run a car, such charges mean a great deal. Those people need their cars to get to hospital to visit their loved ones or to receive treatment. Conservative Members may sneer about that, but such charges are all part of the privatisation of the NHS.

Private consultation for my constituents is becoming the rule rather than the exception. It is the norm for people to have to pay to see a consultant before they are accepted into the system. Frequently they end up paying to visit Methley park hospital for private treatment. They should receive that care within the NHS by right.

It saddens me to know of case after case of elderly people who have paid all their lives towards the NHS and who believe in it. They now have to bribe a doctor to get the treatment that they should get by right. That is an absolute disgrace, but it is the reality in my area and elsewhere.

The public have also witnessed the reconstruction of the NHS—prompted by Government measures—as a com-petitive set of business units. Whether people have trusts in their area or not, the pattern is clear. The introduction of private-sector style management—a great success, according to one Conservative Member—has not been a success in my area. A man who used to run a biscuit factory was brought in to run the local NHS, but the mistakes made during that period are still being put right by the new management.

Conservative Members talk about the devolution of accountability—what absolute rot. What is the role of the community health councils? Supposedly they represent the voice of the patient, but that voice has been made to shut up. In my area, the CHC is no longer able to discuss anything in the meetings of the area health authority. It is unable to have any dialogue on issues of direct concern to it.

Obvious financial incentives have been offered to general practitioners to opt out of the system. I recently received a letter from a local GP in my area who described the way in which financial incentives are offered to GP practices to opt out and to become self-managing. He described the way in which Yorkshire regional health authority operates. He wrote: In order to improve waiting list statistics they are seeking GP's help in removing from the waiting-lists those patients who have been waiting longer than one year. I presume they are hoping patients can be referred to a different Provider and so in terms of statistics would start their waiting period again. They are also hoping we will remove patients who have changed addresses, died, no longer need treatment or can be persuaded to opt for private treatment. Fund Holding practices will be paid a 'bounty' for each patient removed from the waiting list and a 'bonus' if on 1st April. 1992 there are no such patients. Yorkshire's Non-fund holding practices are to be asked to carry out the same 'ghost-culling' exercise but will not be paid for doing so. Whilst not giving any direct benefit to patients of Fund Holding practices it allows those practices to gain financially and therefore purchase better equipment and services for their patients. In essence it is a further financial carrot to encourage practices to become fund-holding and to strengthen the position of existing fund holders at the expense of non fund-holders. That is a clear example of the way in which the Government are pushing public money at GPs to persuade them to manage their own budgets.

The Labour party has been accused recently of running a dirty tricks campaign about the NHS. I took particular note of a disgraceful article that appeared in The Sunday Times a week ago on the issue of Dr. Mark Baker moving to a consultant's post within the Yorkshire regional health authority. The news editor of The Sunday Times, Mr. Michael Williams, has accepted that that article contained at least six factual errors. He undertook to print, in full, a letter from me refuting the allegations in the article. I am sorry that Mr. Williams is not a man of his word, as he removed the main point of my letter—that Dr. Mark Baker had confirmed on BBC television the precise information I had released.

There is no need for dirty tricks, as it is quite apparent—

Madam Deputy Speaker (Miss Betty Boothroyd)

Order. The hon. Gentleman has had his time.

7.48 pm

Mr. James Couchman (Gillingham)

In common with my hon. Friend the Member for Northampton, South (Mr. Morris) may I first declare that I have an interest in two health care companies? I advise Pfizer, which is a Kent-based pharmaceutical manufacturer, and Denplan Ltd.

In common with my hon. Friend the Member for Dorset, West (Sir J. Spicer), may I also declare a family interest? Like the vast majority of the population, my family and I use the NHS for all our health care. Some colleagues will be aware that, during the past 18 months, my wife has been a cancer patient at Guy's hospital. During that time, she has received superb treatment and enjoyed the morale of the staff, which is extremely good. Throughout her serious illness, she has always been treated in a most encouraging manner. My family has always enjoyed satisfaction from the health service, and we use it exclusively for our health care.

I find it deeply insulting when Labour Members accuse us of wishing to privatise the health service. Why would we, who have enjoyed satisfaction from the national health service, wish to deprive others of such satisfaction? Opposition Members' actions in the past few months seem to have much more to do with propanganda and scare than with telling the truth about the health service as it is or would be under a Labour Government. It is regrettable that the nostrum of those propagandists of the 1930s and 1940s—that if a fabrication is repeated often enough it will be believed—has been taken up by Opposition Front-Bench Members.

I remember sitting throughout the entirety of the Bill for the reform of the health service that we are now discussing—the National Health Service and Community Care Bill. During those proceedings, there was little mention of privatisation. That was not the Opposition's objection at that time, and I suspect that their attempt to persuade people that we intend to privatise the health service has much more to do with elections than with telling the truth.

I, too, watched that excellent programme on BBC1 yesterday lunch time in which the hon. Member for Livingstone (Mr. Cook) was interviewed by Jonathan Dimbleby. What a slippery and evasive performance the hon. Gentleman gave, especially in relation to the resources that a Labour Government would provide for the health service. He did not say whether it will be £1 billion, £2 billion, £4 billion or £6 billion, but it does not matter, because the right hon. and learned Member for Monklands, East (Mr. Smith) will not pass over that money in any case.

The right hon. and learned Gentleman will take additional income tax and national insurance from all doctors and most nurses, and not a penny piece of ii will be paid to the national health service, because all that additional revenue has been pledged in social security benefits to pensioners and in child benefit. I wonder how nurses and doctors will feel about that. They will say, "It's back to the same old swings. We remember the last Labour Government when our wages were reduced—nurses' by 3 per cent. and doctors' by 17 per cent."

That is in stark contrast to what the Government have done for the pay of nurses and doctors. In real terms, nurses' pay has gone up by 48 per cent. and doctors' pay by 39 per cent. Since 1979, spending on the health service has increased by 50 per cent. in real terms. The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), who is in his place, mentioned the increases that will be necessary. The Government have kept pace with those, but demand in the health service is infinite. It does not matter how much more money a putative Labour Government might put into the health service, because it would never be enough. It would always be outstripped by medical advance and the number of elderly people who require tremendous extra service.

Some 84 per cent. more patients are now treated in geriatric units. That is partly to do with the fact that it is no longer seen as the end of the road to end up in a geriatric unit bed, because geriatricians now work extremely hard to rehabilitate the elderly when they come into their charge. They may then go to a home outside, where almost all of them are supported by the state in some form. Some 293,000 people are now in homes supported by public funds, compared with 132,000 in 1979. Thus, more than twice as many people are now in homes for the elderly supported by public funds. That is the sort of improvement that has taken place since 1979.

We are constrained to speak for only a brief time this evening, but I should like to have said much more in this debate. I welcome the inquiry that my right hon. Friend the Secretary of State has set up into the situation in London. I was chairman of a health authority before entering the House, and I have long been convinced that

London, especially inner London, is over-provided with health care. There is too great a concentration of high specialist units in the undergraduate teaching hospitals on the three-mile ride from Harley street which we all know and which has been recognised since 1909.

I hope that Sir Bernard Tomlinson, in his wide-ranging inquiry, will consult on the problems caused by over-concentration in London. There is no doubt that the hospitals on the inner London ring are starving constituencies such as mine—30 or 50 miles outside London—of resources. St. Thomas's hospital has had to give associate university status to the hospital in my constituency because insufficient ordinary or secondary care patients are going into St. Thomas's and there must always be 40 medical students at the Medway hospital because more people are living there.

I hope that Sir Bernard will be given a free hand to recommend the movement of those undergraduate teaching facilities out of London and into the provinces where they should be. That would remove at a stroke the reason for keeping too many of those hospitals open. I look forward to Sir Bernard's report being published soon.

7.57 pm

Mr. Robert Hughes (Aberdeen, North)

I shall concentrate on the application for trust status by the Forresterhills hospitals in Aberdeen. The foreword of the application document says: The Hospitals represented in this application have an excellent record of service to the public over many years. They are a most valuable asset for the people of the area and they play an essential role in the lives of each and every one of us. I concur wholly with that and it is interesting that, in the rest of the document, not a single case is made about the applicants, who are involved in the health service in Aberdeen, being frustrated in their management or in making improvements. Nor is there any evidence to say that they could improve on what has gone before, except a vague promise of more flexibility.

On 9 October, which is less than a couple of weeks ago, the 90-day consultation period ended. Within five days of its ending, Grampian health board was able to write to the Secretary of State to say that it upheld and recommended the application. Some will say that it has acted with commendable speed. The Secretary of State for Scotland would certainly not take that view, however, because a local event of national importance is to take place in the locality covered by the hospital—the Kincardine and Deeside by-election.

The electors in that constituency will want to know when the Secretary of State will reply to the application and what response he will give. They will ask the Secretary of State and every Minister who goes there whether they agree with the Tory party candidate in the by-election who is opposed to opt-out status. Everyone is opposed to it, and the application should be refused. If Grampian health board was not prejudiced by its judgment before the application, when it said that the application should go ahead, it, too, would recommend rejection.

As for the consultation process, there were 3,919 responses of which 13 or 0.33 per cent. were for the application; 40 or 1.02 per cent. expressed no opinion, but said that they were certainly concerned; and 3,866–98.65 per cent.—were against the application. In addition, the People's Hospital Campaign in Aberdeen, which I co-chair with my hon. Friend the Member for Aberdeen, South (Mr. Doran), entered a petition bearing 34,627 signatures.

One would think that Grampian health board would take account of the weight of all that evidence. In its letter to the Secretary of State the board says that it is worried about the number of objections, but goes on to discount them. It takes an interesting line, saying that the problem is that 3,559 of the responses were standard letters prepared by the People's Hospital Campaign and cannot be taken into account. The lives of Members of Parliament would be much easier, but we would be a damn sight less popular, if we replied to every standard letter that we received by saying that we did not take them into account. The Secretary of State would be surprised if that were so.

It is an insult to public opinion to reject such responses out of hand. However, let me be more than fair. If the vast number of responses received in the form of the People's Hospital Campaign standard letter are taken out of the total, we are left with 360 responses, of which only 13 were in favour, so the 0.33 per cent. in favour becomes 3.61 per cent.—hardly a mandate to proceed. The balance of judgment is entirely wrong.

Grampian health board's second line of attack is to say that the people do not understand what they are talking about, because they do not understand the process. The unit area medical advisory committee opposed the application. The area medical committee, covering the whole of the Grampian region, objected. The hospital's senior medical staff committee and the local medical committee, which represents general practitioners in the Grampian region, opposed the application. Every organisation and group involved with the health service opposed the application. For the health board to say that people do not understand what is going on is to denigrate all involved with the health service.

We were told that the consultation process was wide. The applicants produced a pamphlet in a tasteful shade of blue that spelt out the trust's advantages. At best, the pamphlet is disingenuous, and it also shows some incompetence. I received my copy only a fortnight before the consultation period ended, and I have no particular reason to believe that I was singled out. At the end, the pamphlet states: Any other comments or expressions of support which you would wish to have taken into account should be sent direct to… It does not state that one can object. That is the so-called open consultation that the Government say they support —the pamphlet is, to put it mildly, disingenuous.

We are told that the proposal involves local choice by local people. The chairman-designate of the trust was approached by the chief executive of the NHS in Edinburgh—such is the local choice that those involved could not even choose their own chairman. What choice will they have once the application goes through? What about the others involved? Who asked them? Is the decision locally inspired, or is it imposed from above? I suspect that it is imposed from above.

The Government say that we are telling a lot of lies about privatisation, but let us consider what is happening in Aberdeen. The health board built, planned and paid for a 60-bed unit for its geriatric and psychogeriatric patients. It was planned that, from the day it opened, it should be run by the health service. But it has been contracted out to be run by a private medical company.

Within the Aberdeen health board district there is a hyperbaric centre which was developed in the 1980s to take care of divers in the North sea who need urgent medical treatment for the bends. That centre was included in the application, but it has already been stripped out. It was sold to a private company on Friday. The medical professionals running that centre have been told to clear their desks and get out within the week because their offices have been sold to a private diving company. The centre does not deal with marginal problems but saves lives; it is of great importance. It was sold off because it would cost money and was an expensive part of the service to develop, which is exactly what we said would happen. Services which are not commercially popular and which will be a drain on funds will be sold off. Another centre which deals with disturbed children who need psychiatric care was stripped from the application because it created difficulties.

Some two thirds of the land is owned by the health board and one third by the university. As the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) asked, will the land be free? Who will pay for it? Do we expect the trust to pay for it? It would never be able to borrow the money to pay for the university land, and the university cannot afford to give it away for nothing. Borrowing the funds would affect patient care. It is an absolute disgrace. Privatisation is proceeding apace and everyone in the House, including Conservative Members, knows it.

Everyone of repute in the Grampian region has opposed the application. Every candidate in the Kincardine and Deeside by-election opposes it. No case has been made approving the application. That is recognised by everyone, including the Tory candidate and every Conservative group on the regional and district councils. Every Conservative is against it. Are all those views to be overridden? It does not matter whether they are or not, because the electorate will override the Secretary of State come the Kincardine and Deeside by-election and, what is more, the electorate will override the Government come the general election. We shall have a service which is true to its principles, is free to people at the time of need and provides the best care. I support that, and I believe that the whole country supports it.

8.6 pm

Mr. Richard Page (Hertfordshire, South-West)

It is fascinating how a phrase or word sometimes encapsulates in the public's mind a concept or idea. It is then either given the fair wind of approval, or rendered stillborn or handicapped at birth. I well remember, when I was in opposition, standing in the Chamber in early 1979 and using the phrase, "a winter of discontent". I do not claim copyright on that phrase, because I understand that an itinerant playwright had used it a few centuries before. But the phrase encapsulated in people's minds the Labour Government's embattled argument with their paymasters. The words used by the hon. Member for Livingston (Mr. Cook) jarred with the truth as he started to say how well the Labour party had treated the national health service during its time in office.

I do not know who developed the phrase "opt out", but in doing so he or she created a fertile base on which the Labour party has been able to develop the various fears that it has put into the public's mind. When Lord Callaghan was Prime Minister, he once said that a lie could be halfway round the world before the truth had got its boots on. I have always borne that in mind, and we must get our boots on if we are to get round the world and nail the lie being circulated about the Government's attitude towards and plans for the national health service. That was one of the reasons why, last Wednesday—

Mr. Robert Litherland (Manchester, Central)

Will the hon. Gentleman give way?

Mr. Page

No, I will not, as I am restricted to 10 minutes.

Last Wednesday, I tabled an early-day motion and immediately received 100 signatures for it. The motion deplored the scares and smears put about by the Opposition, and gave a commitment by Conservative Back Benchers that the health service would not be privatised, but would stay as a national service. I say bluntly that I would find it difficult to be a member of a party that did not provide health care for every man, woman and child in this country, irrespective of their private means.

Constituents have asked me why we are introducing change and proposing trusts which, they say, the doctors and consultants do not want. I have been forced to spend time explaining that the medical profession has not been of the brightest when taking managerial decisions. The medical profession was not in favour of the national health service in the first place.

I remember the furore over the funds for generic drugs. I remember doctors threatening to put up a reply to that idea in their surgeries—at least, that was what was said by doctors who were not on holiday in the West Indies enjoying the hospitality of some of the drug companies. The doctors have complained about budgets and trusts, but some of them are beginning to say that perhaps trusts are not so bad after all. Even their budgets, they say, are fine. They have started to realise what lies behind such schemes.

This series of poor initial judgments by some members of the medical profession has been seized on by the Labour party and used for its own ends. If my constituents persist, I shall also tell them another reason in favour of the changes. For four years, I have been privileged to serve on the Public Accounts Committee, and whenever a national health item comes to my attention, I have two conflicting emotions. The first is that this is a juicy item that we can get our teeth into—such items are always juicy: taxpayers' money is always being wasted. The second feeling is that I should put my head in my hands in despair at this waste of taxpayers' money under the present system. If Opposition Members want to sneer at these changes, I suggest that they work their way through some National Audit Office reports. They can then come back and tell us whether they think some changes should be introduced to the health service.

A recent example concerned health service supplies in England. I was struck by the absence of management data about them. If the NHS had gone out of its way to make life difficult, it could not have done a better job. It was

impossible to compare regional data, because there was no common management system throughout the 14 regions.

I offer a few simple quotes from the NAO report: The absence of readily available information about purchases from individual major suppliers weakens the negotiating position. That is not the best way to look after taxpayers' money. From a commercial point of view, it is the most damning part of the exercise: The NHS lacks the detailed data needed to carry out more penetrating but selective reviews of key business factors". The plain fact is that the system does not have the information on which to make the necessary judgments.

The NAO found that such basic information as a list of the top 50 items by value purchased in the past two years was not available. Even the top 30 suppliers to each region could not be named.

I could go on, but I will not. I will not discuss the report on patient transport services or that on operating theatres, although I am glad to say that, following the NAO's report and the PAC's report, the usage percentage has risen from 50 or 60 per cent. to between 75 and 90 per cent.

There is no time to discuss the detail of the trusts or how they can be more efficient and can save taxpayers' money, allowing that money to be ploughed back into better services. Central control has not worked. The way forward lies in local control through local choice and local management. People should be paid for what they do. My hon. Friend the Member for Gillingham (Mr. Couchman) talked about money going into London and not into the shires. In the shires, we are doing excellent work and performing a great many operations at even lower cost.

Of course there will be errors and failures among the trusts, but they will be as nothing compared with the overall benefits and advantages.

The unfounded allegations about privatisation are being nailed. When the public realise that they have been duped by the Labour party, the backlash will be terrible, and it will be visited upon Opposition Members when the election comes.

8.14 pm

Mr. Jim Cousins (Newcastle upon Tyne, Central)

It simply will not do for the hon. Member for Hertfordshire, South-West (Mr. Page) to complain about a lack of information in the NHS, given that it was by proceeding so boldly without adequate information that the Government got into the mess that they are in. It was not sensible of the hon. Member for Gillingham (Mr. Couchman) to complain about the Government's belated discovery of the financing problems of the London teaching hospitals. All those things should have been known in advance and represent unnecessary difficulties into which the Government plunged through lack of foresight.

Labour Members are sensible enough not to imagine that the problems of funding teaching hospitals are confined to London. Some of the difficulties experienced by NHS opt-out trusts throughout the country are due to the difficulties in the system that the Government designed to try to fund the activities of medical and dental teaching —precisely the problems that they have now discovered in London.

The Opposition did not invent the ridulous machinery that is now crumbling around the Government. The Government complain about the costs of bureaucracy in the NHS, yet in an effort to control those costs they have utterly failed and, incredibly, costs have soared. In Newcastle upon Tyne, two of the four main hospitals now form NHS opt-out trusts—yet the costs of administering the district health authority have risen by 100 per cent. in two years due to lack of foresight on the part of the Government, who have only themselves to blame. The new, slimmed down Northern regional health authority costs 25 per cent. more to administer now than it did two years ago. These are the Government's failings and no one else's.

It was not the Opposition who decided that it was a fine idea to let private wings sprout in hospitals all over the country. That is what has happened at the Royal Victoria infirmary hospital in Newcastle, and that is proposed for the South Cleveland hospital. It was not the Opposition who designed the consultation procedure for NHS opt-out trusts. Incidentally, the two trusts recently approved for north Tees and south Tees, near the Langbaurgh constituency, failed to attract the support of one Conservative Member of Parliament from their area when applying for trust status.

It was not the Opposition who looked at the old long-stay geriatric hospitals, which were certainly a problem, and came up with the brillant solution of putting their inmates up for auction. Yet that is what happened at Ponteland and Lemington hospitals on Tyneside. The Government designed that solution. If they do not like the term "privatisation", I remind them that it was a term of their own devising and implementation.

The Opposition were not responsible for a system in which two hospitals in the same city compete by fair means or foul for the right to house a new fast-track cataract surgery unit. The north and south of the Northern region, in the system that the Government devised, are locked in combat over whether the monopoly of the Freeman hospital trust can be sufficiently broken to allow the southern end of the region on Teesside to have its own heart unit. Those difficulties were of the Government's own making.

The Opposition did not devise the system in which, in an effort to save its own budget, the Freeman hospital trust required kidney patients to go and collect prescriptions from their GPs at a cost of £3.40 and bring them back to the hospital for storage. The chairman of the Freeman hospital trust, who was once in the removal business, explained matters thus: It is not a question of the Trust avoiding necessary expenditure or endeavouring to deflect the revenue burden into the primary care sector. It is however a question of choice and determination of priorities within a given resource allocation ". We did not devise the system whereby such short-changing in patient care can go on.

Miss D, one of my constituents, wants a cataract operation, and went for an NHS referral. She was told that she would have to wait 35 weeks for an out-patient appointment. However, Mrs. C. went to a consultant at the Freeman hospital trust, paid £25, and was told that the operation will cost £2,000, which she cannot afford. She was then accepted on the NHS waiting list for that hospital as an NHS referral. I am trying to have the £25 returned to her because, as she is an NHS referral, she is entitled to have her money back. The Opposition did not devise that system.

We also did not produce a report on the health of the nation which clearly demonstrates that a low-paid manual worker, his partner, his child and his parents will have an experience of illness dramatically different from that of people who are not low-paid manual workers. Conservative Members should bear that in mind in all our debates about low pay and a minimum wage. Attacking low pay through a minimum wage will make one of the most important contributions to the improvement of health that can possibly be made. We did not discover that information, but we have demonstrated that our policies will recover the situation and that we have the person to do it. I only wish that the opportunity which is coming our way could come a little faster.

8.21 pm

Mr. John Carlisle (Luton, North)

I shall not follow the line taken by the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins). I represent a constituency in the North-West Thames region and agree with the view of my hon. Friend the Member for Gillingham (Mr. Couchman), reinforced by my hon. Friend the Member for Hertfordshire, South-West (Mr. Page), about money going from London to the shire counties. We have collectively been campaigning on that since I came to the House. Many London hospitals are greatly overfunded and under-subscribed. If some of the funds and the manpower were switched from London, they might solve some of our problems.

My constituency has one of the best known hospitals adjacent to the M1—the Luton and Dunstable hospital, which, I am glad to say, has successfully applied for trust status, as has the South Bedfordshire health care unit. In the time that I have been privileged to represent them in this place, I can count on the fingers of one hand the number of letters of complaint that I have had about the hospital service. It would be foolish to say that we do not have problems, but the hospitals have a fine record, a fine body of people running them and excellent doctors and nurses. In emergencies which occur because of the hospital's proximity to that major road, the staff do a wonderful job.

It is sad that campaigns against the trust application mounted by local people, and especially by the local Labour council, have found favour in some areas. Many of the fears and smears expressed by both Opposition parties have inevitably stuck, and many untruths have been expressed in and around my constituency by those promoting their own cause.

In May, for the first time in 15 years, Luton borough council had a Labour majority, which spent more than £20,000 on an opinion poll about whether the hospitals should have trust status. Out of the total resident population of 280,000 available to the hospitals, about 40,000 people in the borough of Luton took part in the opinion poll, and the majority was 3:1 for the hospital not becoming a trust. Such a result is quite understandable, in view of the campaign mounted by the Labour party.

The main reason for that decision was ignorance, and for that, some of us on the Conservative side can take some of the blame. However, much of it was due to the political manoeuvring of the Opposition, who unashamedly played on the fears of the most needy in our population. I cannot speak for other areas, but certainly in my area the Opposition campaign was disgraceful and will rebound upon them.

Labour and Liberal parties complain that not enough consultation took place before trust status was sought, and they say that the public were not consulted. I think the Opposition have also said that the medical profession itself was not consulted. South Bedfordshire health care unit wrote to 120 doctors inviting their comments and asking them to attend a meeting. Only six doctors responded. How can they complain about not being consulted?

South Bedfordshire placed newspaper advertisements about meetings in the area and, in particular, advertising a meeting in Luton which has a population of about 150,000. Despite massive advertising, only one citizen turned up at the Luton meeting. That shows that the Opposition may be hanging their hats on a rather spurious peg, because the public have not shown the interest that we would like them to show. People have been stirred up by misinformation, especially by the Opposition.

About two years ago, when trust status was first considered, consultants, doctors, nursing staff and hospital staff expressed opposition to the idea. That was understandable, because it was unknown territory and they did not know where they were going. Some of the opposition was forthright, and was certainly made known to me. Since then, it has been accurately reported that many consultants are in favour, and a recent expression of opinion showed that a majority are in favour. Nurses and doctors are also well on the side of trust status.

Opposition Members should note that members of the Confederation of Health Service Employees and the National Union of Public Employees have told hospital management that they are quite willing to work with them towards the trust coming to fruition next April. They also wish to be kept informed of proceedings. The Opposition think that they have everybody, including their favourite unions, on their side. Opposition Members who are sponsored by unions should go to their union bosses or, perhaps more importantly, to union members and ask them whether they are as opposed to trusts as their parliamentary representativess make them out to be. People in those unions understand that the welfare of those who work in the health service, certainly in my constituency, will be enhanced by trust status as they set their own starting levels, pay levels and conditions.

The Opposition do not seem to want to know that, for the first time in 26 years, hospitals are being returned to the people, who will control them. Through their representatives in the House and on the board, the people of Luton will be able to make known the needs of the area. Weasel words and siren voices from the Opposition will not be heard when the trusts come to fruition.

This is an exciting time for the health service; thank heavens the Government have had the courage not to throw money at the problem, as the Opposition would do, but are doing something about it. I congratulate my right hon. Friend the Secretary of State and his team on their courageous step, which will be more than welcome in my constituency and throughout the country. At the end of the day, we shall have a national health service of which we can be proud.

8.29 pm

Mrs. Rosie Barnes (Greenwich)

Today's debate, like that over recent weeks, has been in something of a cul-de-sac. We have all opposed privatisation, questioned whether the motive behind these reforms was privatisation and asked, if it is, whether that is a good thing and, if it is not, what should be done in its place. Hon. Members on both sides of the House have suggested that privatisation may have been high on the agenda under the former Prime Minister. I have no doubt that there has been a change in direction and I feel more comfortable about the NHS because I believe that the current Prime Minister and Secretary of State do not intend to privatise it. That does not mean that I welcome these reforms, because they are fundamentally flawed and will not take the NHS in the right direction and solve the problems that it faces.

The NHS is underfunded. We spend a lower proportion of our gross domestic product on the NHS than do the United States or most of our European counterparts. We are way behind them, and we must redress that balance.

Mrs. Ann Winterton (Congleton)

Is it not true that in the United States and on the continent, patients pay their own money when they go to see the doctor, while our system is free at the point of delivery and is supported by taxation?

Mrs. Barnes

Our system is largely supported through taxation, but, regrettably, charges are creeping into the system and they have to be added into the calculation.

There has to be increased funding to take account both of the increasing number of elderly people, who are expensive to treat, and improved technology. To some extent, the NHS is the victim of its own success. People are kept alive longer, so they are expensive when they are elderly, and the equipment to keep them alive is often expensive high technology. The loving care administered in the early days of the NHS required little treatment and so was much cheaper.

Therefore, it is worth reconsidering the introduction of an hypothecated tax, with a portion of income tax earmarked to go to the health service. People do not like paying tax or increases in tax. They prefer their taxes to he reduced, but there is a general agreement that they want the safety net of a health service that offers every facility when they or theirs want it. People would be prepared to pay a higher percentage of the gross domestic product towards the health service if they knew that that was where that portion of their income tax was going.

Some of the arguments about what has been described as the internal market could have been avoided. One of the first things that I did when I came here as a Member of Parliament in 1987 was to table an amendment to the Health and Medicines Bill to introduce a new form of patients' right, giving patients some control over their share of the NHS money. It would enable them to initiate the decision to go to an alternative health authority or even to the private sector, taking with them their share of the NHS money, if their health authority was not in a position to deliver the treatment that they needed within a reasonable time.

I did not think that we could promise utopia, so I suggested that the time in question should be based on what the 20 per cent. of best health authorities were delivering in the speciality. That would become the national benchmark time within which people were entitled to be treated. For example, if the top 20 health authorities were able to deliver hip replacements, where diagnosed as necessary, within five or six months, that would become the national benchmark. If a health authority could not give such treatment within that time, the patient would be entitled to make the decision to take his share of the NHS money and go elsewhere.

That form of internal market would have introduced a competitive edge into the NHS. Furthermore, the pivotal point of the decision-making process would have been not the doctor, but the patient. The decision would not be imposed on the patient. If he wanted to stay where he was and wait longer, that would be his choice. Apart from making the health service national—it is not at present —it would also have had the benefit of not destroying the doctor-patient relationship. Under the Government's proposals, the patient may feel that a decision is being imposed on him because it is the cheapest way to treat his case, not because it is the best or quickest way to do it or involves using the nearest hospital. That may not always be the case and I do not assert that all doctors work on that basis, but introducing a financial complication in the doctor-patient relationship is a regressive step.

The Government's proposals endanger the Cinderella services—geriatric and psychiatric care. The hospitals that choose to become trusts in the first and second waves may decide to push those services to one side because they are expensive and do not show up well on the economic indicators, and that will deprive the communities that they serve. I endorse further consideration of the possibility of making whole district health authorities trusts so that some of the devolution of power, some of the autonomy and some of the decision-making can be made at more local levels, taking into consideration the total provision for everybody in the community and ensuring a proper balance of what is needed across the board. That is preferable to one hospital going for the profitable services and booting out the others.

The Government's proposals will fragment rather than integrate the health service. General practitioners and hospitals should come under one umbrella and work closely together. The present system forces them apart. Doctors try to push treatment on to the hospital budgets and hospitals try to push treatment on to doctors' budgets. A district area trust would enable them to work together more harmoniously.

I have been worried by the glee with which the London hospital review has been picked up by representatives of the shires, who have shown their conviction that London has too much hospital provision, and even a surplus. As Member of Parliament for Greenwich, I have no such experience. I find that things have got marginally worse since some of the teaching hospitals which the residents of Greenwich have traditionally used have become self-governing. Where Greenwich district health authority has a contract with hospitals such as Guy's and St. Thomas's, people are not getting treatment more swiftly and efficiently than they were under the old system.

I am not talking about the conditions that will not worsen while people wait for treatment: I am talking about treatment such as radiotherapy for breast cancer. Recently, a woman came to my surgery to tell me that she had been diagnosed as having cancer of the breast; she was told that her condition was inoperable, that radiotherapy was important and that she should start as soon as possible. On being referred to Guy's she found that there was a long waiting list for this treatment. Others have come to me with stories of how they have to wait for surgery for their kidney problems.

In the last few moments available to me, I draw the attention of the House to some research in which I was involved in the mid-1980s before I came to the House.

Madam Deputy Speaker

Order. I am sorry, but the hon. Lady has run out of time.

8.39 pm

Mrs. Ann Winterton (Congleton)

It is always a pleasure to follow the hon. Member for Greenwich (Mrs. Barnes), and I hope that the intervention that she generously allowed me to make did not reduce her time. Her speech was thoughtful and constructive, and she outlined some of her reservations about the present reforms. However, in her speech one could trace several elements of common ground, not least on the issue of single trust status for a health authority district.

I am grateful for the opportunity to add my voice to the reassurances given by my right hon. Friends the Prime Minister and Secretary of State about the future of the national health service in the Government's hands. I, too, am a national health service patient and have, on the whole, received good treatment from it—with one exception, when I was the subject of negligence in the casualty department of a hospital at the time of a socialist Administration. I have no doubt that that hospital would have said that it was understaffed and underfunded, but I am realistic enought to know that mistakes can be made and problems can occur, and that whichever party is in government will try to do its best for the health service.

It must be repeated time and again that our national health service is unique, that it is free at the point of delivery to patients in the doctor's surgery and in the hospital, and that it is maintained through taxation. I am pleased that assurances have been given that that will remain so.

The facts are undeniable, not least that the Government have increased expenditure on the national health service at 3 per cent. above the rate of inflation each year since they were elected, with the cumulative effect of an increase of more than 50 per cent. I accept—as, I believe, would everyone with any common sense—that that is not enough, nor ever could be enough, and that the introduction of reforms makes added expenditure necessary. The reorganisation process soaks up valuable funds which could be directed to patient care.

There is a commitment to the national health service. It is all well and good for other parties to say that they would change things in the future, but in the past they have never been able to generate the money and put it where their mouths are. Conservative Governments have been in office longer than any other during the lifetime of the national health service, and during that lifetime—especially in the past 12 years—there has been a tremendous increase in capital expenditure on new hospitals which were badly needed. In the Macclesfield health authority area we have benefited from a new district general hospital on which about £11.5 million has been spent.

We know that money is not everything—it is how the money is spent that is so important. The Government not only are committed to ensuring the continuation of the health service which, as we know, is dear to the hearts of every citizen, but seek to improve the service, to make it more patient-sensitive and to return decision making about local health matters to where the decisions can best be taken, which is locally.

The health service faces challenges, and there are problems that need to be tackled. Indeed, health care has changed dramatically in the past two decades. Nowadays people live longer and new techniques have been developed to improve the quality of life. One has only to talk to people who have had new hip, knee or elbow operations to know what I mean—their lives have been truly transformed. New pharmaceutical products have been developed and have played a full part in therapeutic care, and diagnostic facilities such as scanners are now widely used. All that is to be welcomed.

Professionals are being encouraged to play their part in the management of the service—consultants, doctors, nurses and midwives. I make a plea for the latter group. I believe that, in the regrading which took place before the reforms were introduced, midwives came badly unstuck. We should recognise the unique skills of the midwife and the part that she plays in caring for women before, during and after birth, and also in caring for the newborn. The midwife's expertise cannot be replaced by others, and this country needs a well recruited and trained midwifery profession which is also well remunerated in accordance with the responsibilities undertaken.

I believe that many of the fears expressed about the future of the national health service stem from the fact that people do not understand the reforms or the way in which they are being implemented. Any change is anathema to those who do not realise that the NHS cannot be left in a fossilised state but must change to meet the challenges that I described earlier, not least the demographic changes.

Two health authorities—Crewe and Macclesfield—cover my constituency of Congleton. Leighton hospital, under Crewe health authority, was in the first wave of hospital trusts. Although not without difficulty, it has made steady progress and due to its greater flexibility it is able to respond more quickly to problems that arise. For example, the air conditioning plant in the operating theatres is at long last being tackled. That will affect the number of operations in the short term, as two theatres are out of commission while the work is being done, but it will assist in the long term and we shall not face the situation that we experienced this summer when theatre sessions were postponed because of the condition of the air and the heat.

The hospital, with its new trust status and also previously under the Crewe district health authority, has historically been underfunded because Liverpool has taken the lion's share of the resources within the Mersey regional health authority. It is not a question of the overall amount, but of how that money is allocated. That situation is being rectified and extra funding allocated to us again this year but, sadly, that funding is not coming fast enough. As in London, we wish to see a change in the way funds are given to different areas within the Mersey region.

Macclesfield health authority has expressed interest in applying for trust status in the third wave of applications, and I welcome the fact that the acute unit at the district general hospital and the community services are to go forward, I hope, as a single unit. That is a common sense approach which should greatly benefit the Congleton War Memorial hospital which lies on the periphery of the health authority area. That excellent local community hospital was founded after the first world war and was built and run by local subscription. Low-wage earners in the textile mills contributed a penny a week from their wages, and that commitment and support for the hospital is ingrained in the character of the people.

Over the years, as health care has changed, we have lost the operating theatre and the maternity unit, both of which we fought hard to retain. It should be noted that one of those facilities was lost under a socialist Administration and one under a Conservative Administration. We now believe that services to local people can be enhanced and that Congleton War Memorial hospital will play an increasingly important role in the successful provision of health care for my constituents.

I wish to mention community care briefly. Cranage Hall hospital in my constituency is a hospital home for the mentally handicapped. The Parliamentary Under-Secretary of State for Health, my hon. Friend the Member for Loughborough (Mr. Dorrell), recently visited it. I am concerned about the rate at which care in the community is being implemented. I have been to see people with a mental handicap who are now living in the community. A first-rate job is being done, and they are extremely happy. However, it must be remembered that to support those people in the community costs a huge amount of money.

Other people could also possibly benefit from living in the community, but there will always be a hard core of mentally and physically handicapped people who will have to live in what is called an institution but which often is, or can be, a comfortable hospital home. Asylum facilities must always be retained with all the treatments which are necessary—for example, the hydropool and physioth-erapy. These facilities should be centres of excellence, and I hope that, in the plans for the future, such ideas will be taken on board and that action will be taken to ensure that those facilities are available for all handicapped people.

8.49 pm

Mr. Martin Redmond (Don Valley)

This afternoon, we saw the spectacle of a Secretary of State in retreat, but it was not a capitulation. It was a tactical retreat by the Secretary of State, and an attempt to confuse the issue and to confuse the public in the hope of conning them into thinking that the national health service is safe in the Government's hands.

I have said clearly from the start that the Conservative Government are after a two-tier health system, with a private element, similar to the system in the United States. Anyone who wants that system should go over there and try it: it brings pain and misery. I believe passionately in the health service, so I want to protect it for the public. Regrettably, it appears that the Conservative Government do not.

The Government talk about democracy and about informing people. Perhaps they should inform the public of their true intentions towards the health service. If they want the people to have a say, they could have supported my ten-minute Bill which called for a referendum on opt-outs, or they could test the public with a general election. That might be the way forward.

The Government have said time and again that they intend to give power back to the people. The reverse has happened, because power has come to central Government. The great pity is that there is no local democracy and no accountability. The trusts are now in total control, and the general public have no access or input to decisions made about their health. The Conservative Government talk about consulting people, but the consultation is a sham.

Only the trusts and the Secretary of State have access to the financial business plan. Neither Trent regional health authority nor the local health authority has access to the financial business plans, yet we are expected to make a decision on their viability. It is a great pity.

In the old days, Doncaster health authority had 4.5 per cent. admin costs. I was proud to be part of that. Regrettably, since the trust has taken over, the budget has yo-yoed in a way that should give the Secretary of State grave concern. The trust does not seem able to manage its finances, yet the local health authority appears to be indifferent to what is going on in relation to the trust.

It has been said that the waiting lists are coming down. I want to draw attention to the unemployment list and to the way in which the Government have fiddled the figures, which do not reflect reality. The Minister may shake his head, but there are ways in which to fiddle the figures. I am sure that the Minister is aware of that and of the fact that that is taking place. I want no shaking of heads.

It is clear that the Doncaster Royal infirmary/Montagu trust has increased admin costs. Mr. Nicholson, the chief executive, used to be on about £30,000; he is now on approximately £55,000. There is the expense of another tier of administration, and it is disgraceful, because the money could be spent on improving the health care of patients.

When I asked about the chairman-elect of the new trust at Tickhill Road/St. Catherine's, Mr. Horsebury, I was told that he was not the chairman-elect. I lay money on the fact that he will be. When I asked Baroness Hooper about the appointment, I was told that it had been put forward by the Doncaster trust. When I asked Mike Bone, the executive officer, he said that the appointment had been put to them by the Department of Health. Either Baroness Hooper or Mike Bone is wrong. They cannot both be right. If they want to lie about silly things like that—

Madam Deputy Speaker

Order. I am sure that the hon. Gentleman realises that the word that he has just used must be withdrawn.

Mr. Redmond

I withdraw it completely, Madam Deputy Speaker. There have certainly been some misleading statements from the—

Madam Deputy Speaker

Order. "Misleading" is also an unacceptable word here.

Mr. Redmond

They have certainly conned people, Madam Deputy Speaker.

A constituent of mine in Conisborough was going for dialysis treatment to a Sheffield hospital. The group attending that session had to make their own way to the hospital by public transport. A complaint was made to me which I took up. Everyone attending the Wednesday session, bar my constituent, now has transport provided by the Sheffield hospital. He has obviously been victimised by the system for having complained to his Member of Parliament.

Another constituent has complained about the treatment that his wife gets at the Wednesday session at the new Tickhill Road/St. Catherine's trust. He has been told that his wife cannot go to the Wednesday session because the two nurses there are off sick. What is happening to treatment?

In the past, charity funds were given to the hospital for the extras—the cream on the cake. The charity funds are now being used to provide basic care, which is disgusting. The money from one fund-raising activity was not spent in the way that was intended. That may not be illegal, but it is immoral.

If the public want a guarantee about the future of the NHS, they can do only one sensible thing. They must demand a general election, vote Labour and ensure that the NHS is safe for future generations.

8.57 pm

Mr. David Wilshire (Spelthorne)

The Labour party's performance over the past few months has been utterly sickening, and their performance this afternoon has been breathtaking in its arrogance—in the party's complete refusal to answer in clear words, or in any words, three simple questions.

What the House needs, and what the nation deserves, is the truth. The truth is this: the state of affairs in the nation is not as Labour claims. If the public are told the truth, they support the Government's proposals; if the campaigners against change tell the truth, they must admit that their opposition to those proposals takes the form of orchestrated self-interest, rather than genuine concern for the sick and the elderly. As for the truth about NHS trusts, if people consider and discuss the facts, rather than simply trying to scare others, it will become clear that trusts will lead to better public health care for all.

Rather than swapping the kind of ill-researched generalities that the Labour party likes to use, let me try to get at the truth by referring to a case study. Ashford hospital, Middlesex, is in my constituency— [Interruption.] If hon. Members would listen, they too could get at the truth, rather than trying to blind the world with their bias.

Ashford hospital is one of the two district general hospitals in the Hounslow and Spelthorne district health authority area. When they use the hospital, its patients —my constituents —simply do not recognise the scare stories put about by the Labour party; they see those stories as fantasy. The waiting list at that hospital has been greatly reduced: it is one of the shortest in my part of south-east England, and is far shorter than it was when I became the local Member of Parliament four years ago. The hospital has the lowest costs in the area. None of us, professionals or lay people, know what the costs really were before the Government's reforms were introduced.

Let me give an example. The cost of general surgery at Ashford hospital is £887 per patient. At the other hospital in my district, the cost is £2,060. At the five other local hospitals outside my district, the highest cost is £1,400 and the lowest £1,200. Ashford hospital is significantly cheaper, and makes better use of money; but, before the reforms, we simply did not know that. My constituents now have quicker access to treatment, and about twice as many patients can be treated in a low-cost hospital as can be treated in a high-cost hospital.

Let us test Labour's claims about public opinion against the true position of Ashford hospital. Labour tells us that consultants are against the Government's proposals. Consultants at Ashford carried out a public vote: 32 were in favour of the proposals, while six opposed them. The director of nursing researched nurse opinion, and reported that 50 per cent. supported the changes, while 50 per cent. were neutral—not against.

Detailed consultation on personal issues took place with other staff. Only recently, all the portering staff were invited to take part in a discussion. The only subject that concerned them was whether their jobs were secure, not whether the proposals would benefit patients.

Then there is the question of public opinion. As the local Member of Parliament, I have received fewer than half a dozen letters opposing trust status. The community health council held a meeting, to which just 40 of my 70,000 constituents turned up. The hospital held four public meetings. At the first three, about 50 people were present; at the second, third and fourth, more than 20 who attended were the same people as before, asking the same questions; at the fourth, just 140 were there.

Seventy-three letters were written to the region about the application for trust status. In one of my local newspapers, an anti-Government pressure group admitted that it had written 67 of those letters. The group claimed that the fact that only six letters opposing the trust had been received by the region demonstrated apathy. It does not: it demonstrates the contentment of the people I represent.

Let us now test Labour's claims about the spontaneity and genuineness of opposition to trust status. I suffer from the presence in my constituency of a very vocal anti-Government pressure group—[HON. MEMBERS: "It is called the Labour party."] No, it is not the Labour party; the Labour party will be glad of that in a moment.

That pressure group claims to speak for local people about health care. But the founder of Hospital Alert, which plagues the life out of my constituents, recently spoke at an anti-Government rally of the Workers Revolutionary party, and duped a number of general practitioners into signing an anti-Government petition. She recently addressed an "all trade union alliance" conference which called for a general strike to bring down the Tory Government. That is the truth about the campaign against NHS trusts at Ashford. It is not spontaneous; it is not on behalf of the public; and it is not altruistic. It is orchestrated, it is individual and it is cynically self-seeking.

Let us test Labour's scare stories about NHS trusts against the truth at Ashford. We are all grateful to my right hon. Friend the Secretary of State for including Ashford in the second wave. As I have said, the professionals and the managers at Ashford and the lay people in my constituency have joined to support what has happened. We believe that more people will benefit from the shorter waiting lists, and more people will be treated at lower cost at Ashford as a result of trust status. Everyone in my constituency will benefit from local priorities being decided locally.

The case study that I have described shows that the truth is not as Labour claims it to be. The Government's reforms have received professional and lay support. Despite what Labour says, those reforms will produce better local services. They will make the NHS in my constituency much more public and much less private—if that is the gibe that the Labour party wants to throw about.

I believe that the country is beginning to understand clearly that my right hon. Friend the Prime Minister is telling the truth. As a Government and a party, we have improved and will continue to improve the NHS. We have no plans, and never will have plans, to privatise the NHS. That is not the truth. To claim otherwise ignores the facts that stare people in the face. If the Labour party continues to indulge in the politics of the sewer, it will reap the rewards that it justly deserves.

9.6 pm

Rev. Martin Smyth (Belfast, South)

We all appreciated the contribution from the hon. Member for Spelthorne (Mr. Wilshire). However, I recall that one rule of logic is not to argue from the particular to the general and reach a conclusion covering all. I was glad to learn that the hon. Gentleman is happy about what is happening in Ashford, but there are concerns about the national situation.

I am delighted to be able to contribute to the debate and was pleased to see that the Minister responsible for health care in Northern Ireland was on the Government Front Bench earlier. We are talking about the national health service.

Like other hon. Members, I commit myself to the NHS. My wife and I are NHS patients and my daughter serves in the NHS. I served on the old Social Services Select Committee and I am currently a member of the Select Committee on Health. When we carried out an objective study into NHS funding, we discovered that it was massively underfunded. At that time, we were shot down by the Government's response. I am happy to acknowledge that since then a tremendous amount of money has been poured into the health service. However, having said that, anyone who believes that the health service is as perfect as we would like it to be, is not living in the real world. I want to contribute to the debate because I am concerned that we should continue to improve the NHS.

The hon. Member for Hertfordshire, South-West (Mr. Page) dismissed the doctors' participation and called them hopeless managers, while the hon. Member for Congleton (Mrs. Winterton) welcomed the fact that we now have professionals—including doctors and nurses—in the management of the health service. I favour the view of the hon. Member for Congleton. I appreciate that not every doctor will be a good manager. However, when we moved from administrators to general management, did we significantly improve the management of the health service? I believe that we did not. In moments of cynicism I believe that we simply changed the title of "administrator" and handed several thousands of pounds more to general managers who just continued not to do the work that they should have been doing before. If people believe that no improvements can be made in the health service, they are not living in the real world.

We should not be conned into thinking that movements forward at this moment will be the panacea of all ills. I am thinking, for example of ordinary patients. A woman whom I visited in my constituency on Saturday morning has been a patient in the health service since the mid-1970s. Among other problems, she has an abscess in her breast. If only she could be operated on, as the medical folk realise the situation. The hospital sent a letter informing her that there was no bed available for her but it included a note saying that an amenity bed would be available.

I thought that that must be like Conservative party central office sending me a letter under the signature of the chairman of the Conservative party, the right hon. Member for Bath (Mr. Patten), looking for subscriptions for and membership of the Tory party. The Conservatives have only recently been prepared to organise in Northern Ireland whereas hitherto they were not. I suspect that the relevant person in the health service was travelling more on hope than on confidence that a person in a working-class home, after years of illness, could pay for an amenity bed in a national health service hospital. That. was one of the scandals of the matter.

Those who believe that hospital trusts will remedy the situation because we have management at the grass roots level may be due for a shock. Even at that level, managers may not be of the required calibre. If I may repeat the nautical metaphor used by the right hon. Member for Aylesbury (Sir T. Raison), instead of a ship being directed by the Ministry of Defence, it should be directed from the bridge. I often wonder what would have happened at Trafalgar if Nelson had not turned a blind eye to the admiral's signal.

There will be pressure. Those who opt for national health trust status have an instinct that they could be interfered with even more dramatically by directives from the Department than they have already. I trust that, in the coming weeks, hon. Members, regardless of the party that they represent, will realise that, if we make the national health service a political football, we will discover that the general electorate—patients, practitioners and friends of patients—will give another judgment.

9.12 pm

Mr. Robert Hayward (Kingswood)

Time is short, so I shall be brief, but I should like to deal with a comment by the hon. Member for Belfast, South (Rev. Martin Smyth). No hon. Member believes that all is right within the health service. There are many problems in the health service in my constituency with which, unfortunately, I do not have time to deal. However, I shall refer to many of the substantial changes and improvements that I have seen in the past few years. I do that because the hon. Member for Livingston (Mr. Cook) recently came to my constituency. He did not, as would normally be the case, advise me that he intended to do so. He held a press conference outside a hospital in myconstituency—[Interruption.] Opposition Members deride that fact. They fail to recognise that, in so doing, the hon. Gentleman had alongside him the Labour candidate for my constituency, one Councillor Berry, who is leader of the Labour group on Avon council. Councillor Berry was a member of Frenshay health authority.

The Labour party consistently tells us that it is committed to the health service. Let us look at the record of Councillor Berry. He was elected to Frenshay health authority in February 1990. I have with me the minutes of Frenshay health authority for 1990. At the bottom they state, "Apologies, Dr. R. Berry." I have with me the March minutes for Frenshay health authority. [Interruption.] They do not state "apologies". They state: The chairman welcomed Dr. Berry, who was attending the first meeting of the Authority. He might have said that he was also attending the last meeting of the Frenshay health authority.

I say that because I have the April 1990 minutes with me, which state, "Apologies from Dr. Berry." The May 1990 minutes again state, "Apologies from Dr. Berry." The June 1990 minutes also state, "Apologies from Dr. Berry, and the July 1990 minutes again read "Apologies from Dr. Berry." Councillor Dr. Berry was absent from 83 per cent. of the health authority meetings that he was invited to attend. That is the caring Labour party. That is the person whom the hon. Member for Livingston stood alongside, saying, "We believe in and are interested in the health authority." If he is so interested in the health authority, why did Councillor Berry miss 83 per cent. of its meetings?

I should like to ask the hon. Member for Livingston and his hon. Friend the Member for Peckham (Ms. Harman), who is to reply to the debate, why no member of the shadow Treasury team was present on the Opposition Front Bench for the hon. Gentleman's speech. The answer is that they were embarrassed by the expenditure commitments, amounting to billions of pounds, that they knew that the hon. Gentleman would be likely to make. Neither the right hon. and learned Member for Monklands, East (Mr. Smith), nor the hon. Member for Derby, South (Mrs. Beckett), nor any member of the shadow Treasury team, was present for the hon. Gentleman's speech.

During the time the Conservative Government have been in power, and while I have been a Member of Parliament, the hon. Member for Livingston has visited Cosham hospital. When there, he could have mentioned the brand new hospital at Taunton and the one at Weston-super-Mare, or the complete reconstruction of the Bristol eye hospital, all of which are just a few miles from Cosham. He could have referred to the brand new ambulance station in Soundwell road in my constituency, only 450 yd from where he was standing—I know because I measured the distance this weekend.

He could also have referred to the brand new health centre, sited right next door to the hospital at which he was speaking and which had been opened only a few months previously. He could also have walked into Cosham hospital where he would have seen a plaque commemora-ting the opening of a new ward to care for the elderly, especially those suffering from senile dementia. He would not do that, of course, because the plaque commemorated the opening of the new ward by me.

Page 5 of last Saturday's Bristol Evening Post has the headline "Hospital boost for elderly". The article states: Keynsham hospital hopes to open its new 24-place wing for the elderly and mentally ill next summer. Turning over the page, one sees the headline: "Hospital bosses get op theatre go-ahead". That article states: Health chiefs have given the go-ahead for a £5 million scheme for new operating theatres at the Bristol Royal Infirmary. That was only the day after my right hon. Friend the Secretary of State opened a new urology unit at Southmead hospital.

Yes, there are problems in the health service, but we have made enormous advances in the past few years. The benefits are there to be seen in my constituency and the immediately surrounding area by anyone who chooses to look, including the hon. Member for Livingston.

Like the vast majority of people in my constituency, I believe my right hon. Friend the Prime Minister that the health service is not being privatised. So far as I am concerned, it will not be privatised so long as I or anyone else is a patient in it. Unlike the hon. Member for Livingston, I remember 1977 when my grandfather lost his eyesight because his eye operation was cancelled. Twenty years ago, my left arm was not operated on for five hours after I had broken it, simply because an anaesthetist was not available. She had to be brought in from a party. Yes, there are problems in the health service, but we should all recognise that they have existed for a long time.

9.19 pm

Mrs. Alice Mahon (Halifax)

When the Government came into office in 1979, they embarked on a strategy of privatising and selling off Britain by the pound. Privatisation takes many forms. One is to sell off good companies such as Amersham International. Another is to sell off utilities. Another is to introduce private contractors into services such as the national health service. The right hon. Member for Sutton Coldfield (Sir N. Fowler) seemed proud of it, but whatever he may say, the introduction of such private contractors has been devastating. Dedicated, hardworking domestics were sacrificed on the altar of privatisation. We were told that such efficiency savings that were made would be used to improve patient care. What absolute rubbish. Any ward sister will tell one that a domestic is an integral part of the ward team and often acts as the eyes and ears of the ward.

In the Health Select Committee, the National Childbirth Trust told us that a study which it had conducted of women giving birth in hospitals showed an overall post-natal infection rate of 21.9 per cent. It blamed that on the standard of cleanliness in hospitals. The position is so bad that, in their anti-natal classes, the NCT teachers recommend that pregnant women take cleaning materials into hospital with them. In that case it would seem that privatisation breeds germs.

But it is in the wholesale privatisation of the care of the elderly sick that the Government have had such a spectacular success. By squeezing the district health authorities of cash and appointing their friends as chairs and managers of the DHAs, the Government have brought about a major change in health care provision for the elderly sick. It has been changed from a service free at the point of use to one in the private sector where the elderly sick or their relatives are increasingly asked to make a contribution towards their care. Who took that decision? There was no Act of Parliament, but there was a change and a hidden agenda.

In the 1980s, the Government decided that the elderly sick would be called bed blockers and that there would be no long-stay care for them. Relatives were offered lists of private nursing homes. It became impossible to get a bed, or at least to keep it, if one was elderly and sick. That is part of the Government's hidden agenda of privatisation of the NHS.

Earlier this year, Alan Templeton, the chair of Calderdale district health authority, told Calderdale community health council that it was not the responsibility of the DHA to provide long-term institutional nursing care, but that its duty was to support individuals in the community before and after episodes of medical support in hospital. Who gave him or anyone else the right to deny my elderly sick constituents an NHS hospital bed? When was it decided that after a certain age people could no longer have treatment in the NHS?

Why cannot we have NHS nursing homes? I had a case of a woman who was well into her eighties whose daughter had looked after her. Mrs. Jones had diabetes, was blind and needed daily injections. She had ulcers on her legs which needed dressing daily. She was confused and incontinent and she developed pneumonia. She needed medication, medical care, nursing care and a hospital bed. The daughter was told that no hospital bed was available. In the end a bed was found in a private nursing home. You or I would have qualified for a bed, Madam Deputy Speaker. A wicked and cynical policy has developed which redefines illness according to age, and the Government are responsible for it.

Another way to privatise the service is to starve the district health authority of funds, thus lengthening waiting lists for operations and forcing people into the private sector. That is happening increasingly with the elderly. Mr. Only, a 70-year-old pensioner, wrote to me. He had been waiting 17 months for a cataract operation. He was going blind and was told that he would have to wait another six months, but that if he was willing to pay he could have the operation done within days. That is privatisation.

In April we got the market system, based on the American system. That gave us the trusts. We all know that the Government bulldozed the trusts through Parliament. If they are still telling us that the trusts will not be privatised, why is it that the Secretary of State for Health issues circulars for action by all health authorities when it comes to infection control of deadly diseases, such as hepatitis B and HIV, yet when it comes to the trusts he offers the circulars for information only? It is because he has relinquished power over the trusts and the trusts are one general election away from being private hospitals. They are separate bodies, and we know it.

The trusts and the market system are creating great anxiety for staff. They know that their jobs are not safe. The document "Changing Labour Utilisation in NHS Trusts" is causing anxiety to staff. Given the Government's record on privatisation, I do not believe that they do not intend to privatise the health service, and nor do the British people, who will show that at the general election.

9.25 pm

Ms. Harriet Harman (Peckham)

What has been striking about this debate is that, on such an important matter as the national health service, Conservative Members have not been prepared, or have not found the courage, to speak up for their constituents—for all their constituents on waiting lists in pain and anxiety, for all their constituents who have had their operations cancelled and for all their constituents who are worried about their hospitals opting out and whose Member of Parliament refuses to listen to them.

What was striking about the speech of the Secretary of State was that it showed not a glimmer of recognition of the crisis that we all know exists in the NHS. We know, and so do patients who use the NHS, that it is being damaged by a threefold Tory attack: underfunding, commercialisation and privatisation. [HON. MEMBERS: "Rubbish."]

The Secretary of State tried to nit-pick about definitions. He attacked our candidate in Langbaurgh. He has accused us, as have his Ministers, of lying. All that that will do is convince people that the Government are refusing to face up to the crisis of underfunding and scrap the policies for which they have no mandate and not a scrap of public support. It might make the Secretary of State feel better, but it is no way for a Government in office for 12 years to defend their record.

Everyone knows, even if the Secretary of State does not, that underfunding in the NHS has caused long waiting lists. In 1979 there were 690,000 people on waiting lists. By March 1991 there were 900,000. [Interruption.] The all-party Select Committee on Health said that 23 per cent. of those waiting had been waiting for more than a year. [Interruption.] Hon. Members can howl down the figures that I have produced, but they cannot howl down the pain, anguish and misery of all those people on waiting lists.

Several Hon. Members

rose—

Madam Deputy Speaker

Order. The hon. Lady appears not to be giving way, in which case hon. Members should not persist.

Several Hon. Members

rose—

Ms. Harman

I will give way to the hon. Member for Lancaster (Dame E. Kellett-Bowman).

Dame Elaine Kellett-Bowman (Lancaster)

Clearly the hon. Lady was not listening to the Secretary of State's opening speech. Had she been listening, she would have known that those thoroughly misleading figures that she has just given include day cases which were not totted up in those days. She is wholly wrong.

Ms. Harman

The Secretary of State and members of his party can try to sweep away the figures—[HON MEMBERS: "No."]—but if they think that by denying the figures and nit-picking over them they can change the reality of long waiting lists, of which their constituents know, they are wrong. It will not work. All it does is convince their constituents that they are out of touch.

Long waiting lists leave patients in pain and misery and force many people, reluctantly, into the private sector. Many of those who go private feel that they have no alternative if they are to escape from the pain and inconvenience of an indefinite wait for treatment. They do not feel that they are exercising their choice. They feel angry that, despite having paid through their tax and their national insurance for their health care, they cannot get the treatment when they need it. Those who cannot afford to go private feel angry, too, because they know that, if they could pay again, they could see the same doctor, in the same hospital, for the same operation, in the same week. The Secretary of State might not call that privatisation, but that is what the people who are suffering call it.

My hon. Friends the Members for Wakefield (Mr. Hinchliffe) and for Newcastle upon Tyne, Central (Mr. Cousins) have said that people are being driven into the private sector because of underfunding. That underfund-ing has caused district health authorities to cut hospital beds. No doubt the Secretary of State will deny those figures as well, but bed closures have contributed to the huge waiting lists. Since 1979, the NHS has lost 27,000 acute beds. How can it be a sign of modernisation for the NHS to cut the number of its beds but, at the same time, for the private sector to increase its number of beds?

Since 1979 the NHS has suffered the closure of 531 hospitals, the disappearance of one acute hospital bed in five, a backlog of maintenance and repairs equivalent to £1.5 billion and the cancellation of nearly 300,000 operations.

Mr. David Shaw (Dover)

As a chartered accountant, I have listened with interest to the figures that the hon. Lady has quoted. Can she quote the real figure in which my constituents are interested? How much extra would a Labour Government put into the health service? Can she give us the real figure?

Ms. Harman

The difference between the next Labour Government and this Government—[HON. MEMBERS: "Answer the question."]—is that we believe that the NHS has been systematically underfunded for 12 years. We believe that that underfunding needs to be redressed, and we shall begin that task when we come into government. Even if the Government do not know that long waiting lists are causing people to be pushed into the private sector, the private health insurance companies do. They know that long waiting lists are their biggest—

Hon. Members

How much?

Mr. Speaker

Order. Let us settle down.

Ms. Harman

The private health insurance companies know that long waiting lists are forcing people into the private sector. The Secretary of State should look at the brochures of those companies; they talk about people going private because they cannot stand the pain and misery caused by long waiting lists.

The number of people going private has increased under this Government by 188 per cent., largely as a result of long waiting lists. Cash-starved district health authorities are forced into deals with private health care companies to finance new buildings and equipment that they otherwise could not afford. My hon. Friend the Member for Aberdeen, North (Mr. Hughes) quoted the example of Grampian health board, which built a 60-bed unit that now must be run by the private sector.

Today we have again discussed opting out. Once again Conservative Members have tried to peddle the myth that opting out is simply a benign form of devolved management and that no one need worry about it. That is absolute nonsense.

Mr. Thurnham

Will the hon. Lady withdraw her bogus allegation of 330,000 cancelled operations? How on earth did she arrive at that figure, which is simply a wild estimate that has been denounced by health authorities throughout the country? It is wrong, and this is a meaningless, shoddy exercise.

Ms. Harman: Those figures are absolutely accurate. If the hon. Gentleman checks Hansard for February this year he will see a question from one of my hon. Friends asking how many operations were cancelled last year. The Minister of State's answer gave a figure of about 300,000. If it was all right for the Government to calculate the figures on that basis in February, why is it not all right for us to do so in October? The only thing that has changed is that we are nearer an election and the Government are frightened.

Mr. Robert B. James (Hertfordshire, West)

Will the hon. Lady give way?

Ms. Harman

No, I shall not give way again—

Mr. Peter Hardy (Wentworth)

Will my hon. Friend give way?

Ms. Harman: —except to my hon. Friend.

Mr. Hardy

My hon. Friend mentioned opting out. She will be aware that the Government can have no mandate to implement opt-out in South Yorkshire. Is my hon. Friend aware that, despite the fact that the vast majority of people in South Yorkshire thought that the consultation exercise was a waste of time, the overwhelming majority of responses received on the opting out of the South Yorkshire ambulance service were strongly opposed to it? Only four organisations, consisting largely of Tory placemen, offered any support. However, the document that I suspect the Government received on that showed a fraudulent entry that was later tipp-exed out. That reduced by six the number of organisations which supported the proposal. In view of that publication, will my hon. Friend, even at this late stage, invite the Minister to reconsider that fraudulent application?

Ms. Harman

On the basis of the important point that my hon. Friend has made, I hope that the Minister will reconsider the opting out described by my hon. Friend.

People are opposed to opting out because they know that it is not just devolved management. If the Government had wanted to devolve management, they could have done so 12 years ago and it would not have needed legislation. They could have simply done it through the Department of Health. People are against opting out because they know that it severs the link between their hospital and the local community that that hospital serves. They know that it also severs the link between hospitals and the Department of Health, which has responsibility for national strategic planning of the health service.

People are against opting out because they know that the national health service no longer owns its land or hospitals, nor employs the staff. The land, buildings, equipment and contracts of employment are passed over by statute from the Secretary of State to the boards of directors of the hospitals. Those boards of directors can decide whether to sell the land or to hire or fire the staff, and can decide what work the staff do and for whom. They can decide whether to carry out or increase private practice.

May I quote a leaked internal document from the North-West Thames regional health authority? Such documents remain secret. It says enthusiastically that, if Harefield hospital opts out, the prospects will be good for private patient work. It enthuses that opportunities may also exist to increase the work load of Harefield at the expense of other local hospitals. However, it warns that there may be a danger of a cartel, with the Brompton national heart hospital taking the work away from Harefield. That is the language of commerce and business. It is the priority of the marketplace rather than of patient care.

People know that nursing care has already been privatised with a massive public subsidy so that people who used to be able to receive care in geriatric wards or cottage hospitals have no choice but to go to private nursing homes which have been funded by the public sector. There was a 21,000 per cent. increase in the amount of public subsidy for private nursing homes between 1979 and 1990. It rose from £2.5 million in 1979 to £530 million in 1990. That money could have been spent in national health service nursing homes. People do not want to use up their life savings as they are pushed out of acute hospitals into private nursing care with no choice about where to go..

People know that dental charges are pushing dentistry out of the NHS and into the private sector. Dental charges have doubled in the past 10 years, and in some parts of the country it is difficult to find an NHS dentist who will take NHS patients. Eye tests, which provide an important screening service, must be paid for in full except by people who are means-tested or have certain conditions.

The Secretary of State would do well to recognise that it is the combination of long waiting lists, high charges, privatisation in dentistry and nursing homes, and private wings in NHS hospitals that convinces people that the NHS is under threat from the Government. It is because we are concerned about what is happening that we shall redress NHS underfunding, commercialisation and privatisation. In the lifetime of one Parliament, a Labour Government will redress the underfunding which has caused the present financial crisis in the national health service.

Performance agreements for each health authority will include the reduction of waiting lists and times. We shall set up a task force to tackle waiting list black spots and do what a Select Committee on Health wanted the Government to do, but which the Government refused: set up an investigation into the link between waiting lists and the amount of private practice. We shall bring opted-out hospitals back within district health authorities and end the internal market in which district health authorities and hospitals have to buy and sell services. It is no good— [Interruption.]

Mr. Speaker

Order. Let us proceed in good order.

Ms. Harman

It is no good the Secretary of State or the Prime Minister making promises or declarations—people will not believe them, but will judge for themselves on their own experience. Government allegations against us will simply convince people that the Government are hopelessly out of touch.

9.43 pm

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

This was the debate that the Labour party did not want to have—and from its point of view, it was entirely right, because the debate has exposed the hollowness of Labour Members' claim to be interested in the health service.

The initial effect of listening to Labour spokesmen talking about their policies reminds me of nothing so much as looking at an elaborate operatic set. The initial impact is undeniably impressive, but it relies for its effect on ingenious lighting which obscures the detail and on clever choreography which insists that the actors walk with care so as to preserve the illusion of solidity. One wrong step by any of the Labour spokesmen on that set ensures that the whole edifice collapses amid the sound of ripping canvas and splintering timber. That is the spectacle to which the House was treated earlier this afternoon.

Let us look first at underfunding. I have some sympathy with the hon. Member for Livingston (Mr. Cook). After all, he was dealt a wholly impossible brief by his shadow Cabinet colleagues. His brief was to tell the National Association of Health Authorities and Trusts that Labour promised it £4.5 billion, at the same time as telling the British Medical Association that Labour promised it £6 billion, at the same time as the right hon. and learned Member for Monklands, East (Mr. Smith) was going around the prawn cocktail circuit saying that Labour made no pledge at all about health expenditure.

Today, the hon. Member for Livingston finally crashed off the set that he had created and let the cat out of the bag. He committed Labour on expenditure in the following words: "We have done it before, and we will do it again just like last time." As my hon. Friend the Member for Northampton, South (Mr. Morris) reminded us, those are chilling words indeed to anyone on an NHS waiting list or looking for care in an NHS hospital.

I will remind the hon. Gentleman what "just like last time" means. Last time, Labour increased health expenditure by 3.1 per cent. on average in real terms each year it was in office. Three per cent. is a figure to which the Labour party appears to be attached, because in the 1987 general election the Leader of the Opposition, the person so touchingly referred to yesterday by the hon. Member for Livingston as the ultimate authority, their leader, committed the Labour party in the course of this Parliament to increasing expenditure on health by 3 per cent. per year in real terms.

The problem for the hon. Gentleman is that 3.1 per cent., the record between 1974 and 1979 and the commitment of the Leader of the Opposition at the last election, is precisely the record of this Government every year since 1979. Despite all the alarums and excursions, the hon. Member for Livingston has failed to open any difference between his commitments and our record.

I do not dispute for one moment what the hon. Gentleman and his predecessors between 1974 and 1979 would like to have done. The difficulty was that the International Monetary Fund refused to pay the bill. The hon. Gentleman's commitment is to do it again just like last time, but the real issue, as my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) reminded us, is not money—it is management.

Mr. Geoffrey Lofthouse (Pontefract and Castleford)

Will the Minister give way?

Mr. Dorrell

Once, and then no more.

Mr. Lofthouse

Is the hon. Gentleman aware that consultants at Pontefract general infirmary informed me that they have been warned by the health authority not to "over-market"? They must leave room to attract customers from outside the authority's area so as to attract money. Is he further aware that I recently received a letter from three consultants informing me that, due to underfunding, my constituents are receiving what they describe as sub-standard service? Does he not believe them?

Mr. Dorrell

Before leaving the subject of underfund-ing, I will simply observe that a party which says that we are underfunding the health service should have an idea of the amount of the underfunding. It should also give a clear commitment to the electorate about what it would do about underfunding if elected to government.

The hon. Member for Livingston suggests that we should study the record of the Labour Government of 1974–79. I am happy to do so. I shall look at the way in which resources have been used in the health service. Those resources grew at exactly the same rate between 1974 and 1979 as they have grown under this Government since 1979.

Between 1974 and 1979, in-patient treatments rose at an average yearly rate of less than 1 per cent. Since 1979, they have risen at an average of more than 2 per cent. per year. Between 1974 and 1979, in-patient waiting lists rose by nearly half—by 48 per cent. Since 1979, they have fallen by 8 per cent. Between 1974 and 1979, bearing in mind that resources grew at the same rate in that Parliament as they have done since, capital expenditure on new health equipment and buildings in the NHS fell by 28 per cent. Since 1979, that same capital expenditure has risen by 68 per cent. As my right hon. Friend the Member for Sutton Coldfield rightly said, the issue is management—how resources are used within the national health service.

I shall now deal with the issues raised by the hon. Member for Peckham (Ms. Harman)—

Mr. Bob Cryer (Bradford, South)

Will the hon. Gentleman give way?

Mr. Dorrell

I am sure that the hon. Gentleman will wish to sit down so that I can answer the questions asked by his hon. Friend.

The hon. Member for Peckham expressed concern about the decline in the number of acute beds in the national health service. I will read an extract from The Times, which states: Some press reports have given the impression that hospital closures are evidence that our health service is being run down and is doing less for patients … That is just not true, in many cases new and efficient buildings are replacing antiquated ones … I make no apology for the policy of closing hospitals that are no longer needed. Under-used beds cost money that could be better spent elsewhere. Those are not my words but the words of Lord Ennals when he held the office now held by my right hon. Friend the Secretary of State.

The 1974–79 Labour Government recognised, as we have recognised, that a modern health service needs fewer acute beds to treat more patients. Under Labour, acute bed space fell by 1.2 per cent. per annum between 1974 and 1979 for exactly the same reason as it has continued to fall since 1979.

The key question is how Labour, if elected to office, would improve the management of the national health service. Labour Front Bench spokesmen have shown precious little interest in that issue. They prefer to spread the privatisation smear, even though they now recognise that the smear does not work. They started by saying that we intend to privatise the health service. They have been convinced that that smear is unworkable and now want to use the growth of charges to create the impression of what they are pleased to call creeping privatisation. That charge does not work either, because my right hon. Friend has drawn attention to an inconvenient detail—that a policy of creeping privatisation by extending charging would be against the law.

The legislation under which the NHS works is perfectly clear. Section 1(2) of the National Health Service Act 1977 states: The services so provided shall be free of charge except in so far as the making and recovery of charges is expressly provided for by that or another enactment. Three specific enactments allow charges, the first being the prescription charge which, as someone rightly said, was introduced by Labour. Secondly, there are opticians' and dentists' charges—also introduced by Labour. So far, that is 2:0 to Labour. Thirdly, charges for eye tests were introduced in 1988. By my mathematics, the extension of charging falls 2:1 to Labour.

Nothing daunted, the Labour Front Bench spokesmen went on to talk about nursing home charges, and nursing homes are an important issue. I had thought that the policy in the White Paper "Caring for People" was a bipartisan one. The Labour party is explicitly committed to supporting it, and it is under that policy that those who need nursing care are provided with it, in the community, in private sector nursing homes. That policy has abolished a waiting list that we inherited in 1979—that for part III accommodation, social care in local authorities.

The Labour party cannot accept the principle of any provision of any sort of care that is not provided in the public sector. Exactly the same principle informs its approach to pay beds. It now pursues a policy of removing pay beds from the health service, which would cut by £100 million the resources available for patient care.

Mr. Brian Wilson (Cunninghame, North)

Will the hon. Gentleman give way?

Mr. Dorrell

No.

The Labour party is also committed to a mimimum wage policy which will result in a further cut of £400 million in the resources available for patient care. It is committed to abolishing market testing, which will cut the amount available for patient care by £50 million.

Mr. Cryer

Will the hon. Gentleman give way?

Mr. Dorrell

No. Then there will be—[Interruption.]

Mr. Speaker

Order. Hon. Members must resume their seats, because the Minister has shown that he will not give way.

Mr. Dorrell

—a further cut of £300 million. That is £750 million-worth of cuts in patient care to which the Labour party is committed, and will introduce if it comes into office.

The hon. Member for Livingston made it clear yesterday that he remains committed to the absurd proposal of flexi-budgets, a proposal that my right hon. Friend the Secretary of State has rightly described as an unworkable mess. The Labour party has not thought it through and is not convincing. The one thing that is clear about flexi-budgets is that they would mean a return to funding health care institutions, rather than funding health authorities to buy the health care for the people in their areas. That will be of interest to those of my hon. Friends who represent constituencies that stand to gain from weighted capitation. My right hon. Friends the Members for Blackpool, South (Sir P. Blaker) and for Finchley (Mrs. M. Thatcher) and my hon. Friends the Members for Calder Valley (Mr. Thompson), for Norwich, North (Mr. Thompson, for Dudley, West (Dr. Blackburn), for Chorley (Mr. Dover) and for Bolton, North-East (Mr. Thurnharn) all stand to lose as a result of the proposal to abolish weighted capitation.

Labour's policies are all of a piece. As my right hon. Friend the Member for Sutton Coldfield said, the Labour party has been consistent since 1979—it has opposed change and then accepted it. It opposed the sale of council houses, trade union reform and every cut in the standard rate of income tax. Now, it is Labour policy not to let the standard rate rise. As my right hon. Friend said, it opposed general managers in the NHS, the limited list and market testing, although it had introduced that in Liverpool. They are a good Opposition. They have learnt how to run scare stories without committing themselves, but to govern is to choose and they are unfit to govern because they are unwilling to choose.

Question put, That the amendment be made:—

The House divided: Ayes 209, Noes 303.

Division No. 231	[10 pm
AYES
Adams, Mrs Irene (Paisley, N.)	Benton, Joseph
Allen, Graham	Bermingham, Gerald
Anderson, Donald	Bidwell, Sydney
Archer, Rt Hon Peter	Blunkett, David
Armstrong, Hilary	Boateng, Paul
Ashley, Rt Hon Jack	Boyes, Roland
Ashton, Joe	Bradley, Keith
Banks, Tony (Newham NW)	Bray, Dr Jeremy
Barnes, Harry (Derbyshire NE)	Brown, Gordon (D'mline E)
Barnes, Mrs Rosie (Greenwich)	Brown, Nicholas (Newcastle E)
Battle, John	Brown, Ron (Edinburgh Leith)
Bell, Stuart	Caborn, Richard
Benn, Rt Hon Tony	Callaghan, Jim
Bennett, A. F. (D'nt'n & R'dish)	Campbell, Ron (Blyth Valley)

Campbell-Savours, D. N.	Lestor, Joan (Eccles)
Canavan, Dennis	Lewis, Terry
Clark, Dr David (S Shields)	Litherland, Robert
Clarke, Tom (Monklands W)	Livingstone, Ken
Clay, Bob	Lloyd, Tony (Stretford)
Clelland, David	Lofthouse, Geoffrey
Clwyd, Mrs Ann	Loyden, Eddie
Cohen, Harry	McAllion, John
Cook, Robin (Livingston)	McAvoy, Thomas
Corbett, Robin	McCartney, Ian
Corbyn, Jeremy	Macdonald, Calum A.
Cousins, Jim	McFall, John
Cox, Tom	McKay, Allen (Barnsley West)
Crowther, Stan	McKelvey, William
Cryer, Bob	McLeish, Henry
Cummings, John	McMaster, Gordon
Cunliffe, Lawrence	McNamara, Kevin
Cunningham, Dr John	McWilliam, John
Darling, Alistair	Madden, Max
Davies, Rt Hon Denzil (Llanelli)	Mahon, Mrs Alice
Davies, Ron (Caerphilly)	Marek, Dr John
Davis, Terry (B'ham Hodge H'I)	Marshall, David (Shettleston)
Dewar, Donald	Marshall, Jim (Leicester S)
Dixon, Don	Martin, Michael J. (Springburn)
Dobson, Frank	Martlew, Eric
Douglas, Dick	Meacher, Michael
Dunwoody, Hon Mrs Gwyneth	Meale, Alan
Eadie, Alexander	Michie, Bill (Sheffield Heeley)
Eastham, Ken	Mitchell, Austin (G't Grimsby)
Edwards, Huw	Molyneaux, Rt Hon James
Evans, John (St Helens N)	Moonie, Dr Lewis
Ewing, Harry (Falkirk E)	Morgan, Rhodri
Field, Frank (Birkenhead)	Morris, Rt Hon A. (W'shawe)
Fields, Terry (L'pool B G'n)	Morris, Rt Hon J. (Aberavon)
Fisher, Mark	Mowlam, Marjorie
Flannery, Martin	Mullin, Chris
Flynn, Paul	Murphy, Paul
Foot, Rt Hon Michael	Nellist, Dave
Foster, Derek	Oakes, Rt Hon Gordon
Foulkes, George	O'Brien, William
Fraser, John	O'Hara, Edward
Fyfe, Maria	O'Neill, Martin
Galloway, George	Orme, Rt Hon Stanley
Garrett, John (Norwich South)	Owen, Rt Hon Dr David
Garrett, Ted (Wallsend)	Parry, Robert
Gilbert, Rt Hon Dr John	Patchett, Terry
Godman, Dr Norman A.	Pendry, Tom
Golding, Mrs Llin	Pike, Peter L.
Gordon, Mildred	Prescott, John
Gould, Bryan	Primarolo, Dawn
Graham, Thomas	Quin, Ms Joyce
Grant, Bernie (Tottenham)	Radice, Giles
Griffiths, Nigel (Edinburgh S)	Randall, Stuart
Griffiths, Win (Bridgend)	Redmond, Martin
Hain, Peter	Rees, Rt Hon Merlyn
Hardy, Peter	Reid, Dr John
Harman, Ms Harriet	Richardson, Jo
Hattersley, Rt Hon Roy	Robertson, George
Haynes, Frank	Robinson, Geoffrey
Heal, Mrs Sylvia	Rogers, Allan
Henderson, Doug	Rooker, Jeff
Hinchliffe, David	Rooney, Terence
Hoey, Kate (Vauxhall)	Ross, Ernie (Dundee W)
Hogg, N. (C'nauld & Kilsyth)	Ross, William (Londonderry E)
Home Robertson, John	Rowlands, Ted
Howarth, George (Knowsley N)	Ruddock, Joan
Howell, Rt Hon D. (S'heath)	Sedgemore, Brian
Hoyle, Doug	Sheerman, Barry
Hughes, John (Coventry NE)	Sheldon, Rt Hon Robert
Hughes, Robert (Aberdeen N)	Shore, Rt Hon Peter
Hughes, Roy (Newport E)	Short, Clare
Ingram, Adam	Sillars, Jim
Janner, Greville	Skinner, Dennis
Jones, Barry (Alyn & Deeside)	Smith, Andrew (Oxford E)
Jones, Martyn (Clwyd S W)	Smith, C. (Isl'ton & F'bury)
Kaufman, Rt Hon Gerald	Smith, Rt Hon J. (Monk'ds E)
Kilfoyle, Peter	Smith, J. P. (Vale of Glam)
Lambie, David	Smyth, Rev Martin (Belfast S)
Leadbitter, Ted	Snape, Peter
Leighton, Ron	Soley, Clive

Steinberg, Gerry	Williams, Rt Hon Alan
Stott, Roger	Williams, Alan W. (Carm'then)
Strang, Gavin	Wilson, Brian
Straw, Jack	Winnick, David
Taylor, Mrs Ann (Dewsbury)	Wise, Mrs Audrey
Thompson, Jack (Wansbeck)	Worthington, Tony
Turner, Dennis	Wray, Jimmy
Vaz, Keith	Young, David (Bolton SE)
Walley, Joan
Wardell, Gareth (Gower)	Tellers for the Ayes:
Wareing, Robert N.	Mr. Ray Powell and
Welsh, Michael (Doncaster N)	Mr. Eric Illsley.
Wigley, Dafydd

NOES
Adley, Robert	Davis, David (Boothferry)
Aitken, Jonathan	Day, Stephen
Alison, Rt Hon Michael	Devlin, Tim
Allason, Rupert	Dickens, Geoffrey
Amery, Rt Hon Julian	Dicks, Terry
Amess, David	Dorrell, Stephen
Arbuthnot, James	Douglas-Hamilton, Lord James
Arnold, Jacques (Gravesham)	Dover, Den
Arnold, Sir Thomas	Dunn, Bob
Ashby, David	Durant, Sir Anthony
Aspinwall, Jack	Eggar, Tim
Atkins, Robert	Emery, Sir Peter
Atkinson, David	Evans, David (Welwyn Hatf'd)
Baker, Nicholas (Dorset N)	Evennett, David
Baldry, Tony	Fairbairn, Sir Nicholas
Batiste, Spencer	Fallon, Michael
Beaumont-Dark, Anthony	Farr, Sir John
Bellingham, Henry	Fenner, Dame Peggy
Bendall, Vivian	Field, Barry (Isle of Wight)
Bennett, Nicholas (Pembroke)	Finsberg, Sir Geoffrey
Bevan, David Gilroy	Fishburn, John Dudley
Bitten, Rt Hon John	Fookes, Dame Janet
Blackburn, Dr John G.	Forth, Eric
Blaker, Rt Hon Sir Peter	Fowler, Rt Hon Sir Norman
Body, Sir Richard	Fox, Sir Marcus
Bonsor, Sir Nicholas	Franks, Cecil
Boswell, Tim	Freeman, Roger
Bottomley, Peter	French, Douglas
Bottomley, Mrs Virginia	Fry, Peter
Bowden, A. (Brighton K'pto'n)	Gale, Roger
Bowden, Gerald (Dulwich)	Gardiner, Sir George
Bowis, John	Gill, Christopher
Boyson, Rt Hon Dr Sir Rhodes	Gilmour, Rt Hon Sir Ian
Braine, Rt Hon Sir Bernard	Glyn, Dr Sir Alan
Brandon-Bravo, Martin	Goodlad, Alastair
Brazier, Julian	Goodson-Wickes, Dr Charles
Bright, Graham	Gorman, Mrs Teresa
Brown, Michael (Brigg & Cl't's)	Gorst, John
Bruce, Ian (Dorset South)	Grant, Sir Anthony (CambsSW)
Buck, Sir Antony	Greenway, Harry (Ealing N)
Budgen, Nicholas	Greenway, John (Ryedale)
Burns, Simon	Gregory, Conal
Burt, Alistair	Griffiths, Peter (Portsmouth N)
Butcher, John	Grist, Ian
Butler, Chris	Ground, Patrick
Carlisle, John, (Luton N)	Grylls, Michael
Carlisle, Kenneth (Lincoln)	Hamilton, Neil (Tatton)
Carrington, Matthew	Hampson, Dr Keith
Cash, William	Hanley, Jeremy
Chalker, Rt Hon Mrs Lynda	Hannam, John
Channon, Rt Hon Paul	Hargreaves, A. (B'ham H'll Gr')
Chapman, Sydney	Hargreaves, Ken (Hyndburn)
Chope, Christopher	Harris, David
Churchill, Mr	Hawkins, Christopher
Clark, Rt Hon Alan (Plymouth)	Hayes, Jerry
Clark, Dr Michael (Rochford)	Hayhoe, Rt Hon Sir Barney
Clark, Rt Hon Sir William	Hayward, Robert
Clarke, Rt Hon K. (Rushcliffe)	Heath, Rt Hon Edward
Conway, Derek	Heathcoat-Amory, David
Coombs, Anthony (Wyre F'rest)	Heseltine, Rt Hon Michael
Coombs, Simon (Swindon)	Hicks, Mrs Maureen (Wolv' NE)
Cope, Rt Hon Sir John	Higgins, Rt Hon Terence L.
Couchman, James	Hill, James
Currie, Mrs Edwina	Hind, Kenneth
Davies, Q. (Stamf'd & Spald'g)	Hogg, Hon Douglas (Gr'th'm)

Hordern, Sir Peter	Oppenheim, Phillip
Howard, Rt Hon Michael	Page, Richard
Howarth, Alan (Strat'd-on-A)	Paice, James
Howarth, G. (Cannock & B'wd)	Parkinson, Rt Hon Cecil
Howell, Rt Hon David (G'dford)	Patnick, Irvine
Howell, Ralph (North Norfolk)	Patten, Rt Hon John
Hughes, Robert G. (Harrow W)	Pattie, Rt Hon Sir Geoffrey
Hunt, Rt Hon David	Pawsey, James
Hunt, Sir John (Ravensbourne)	Porter, Barry (Wirral S)
Hunter, Andrew	Porter, David (Waveney)
Irvine, Michael	Portillo, Michael
Irving, Sir Charles	Powell, William (Corby)
Jack, Michael	Price, Sir David
Jackson, Robert	Raison, Rt Hon Sir Timothy
Janman, Tim	Redwood, John
Jessel, Toby	Renton, Rt Hon Tim
Jones, Gwilym (Cardiff N)	Rhodes James, Sir Robert
Jones, Robert B (Herts W)	Riddick, Graham
Keilett-Bowman, Dame Elaine	Ridley,Rt Hon Nicholas
Key, Robert	Rifkind, Rt Hon Malcolm
King, Roger (B'ham N'thfield)	Roberts, Rt Hon Sir Wyn
King, Rt Hon Tom (Bridgwater)	Roe, Mrs Marion
Kirkhope, Timothy	Rossi, Sir Hugh
Knapman, Roger	Rost, Peter
Knight, Greg (Derby North)	Rowe, Andrew
Knowles, Michael	Rumbold, Rt Hon Mrs Angela
Knox, David	Ryder, Rt Hon Richard
Lamont, Rt Hon Norman	Sackville, Hon Tom
Lang, Rt Hon Ian	Sayeed, Jonathan
Latham, Michael	Scott, Rt Hon Nicholas
Lawrence, Ivan	Shaw, David (Dover)
Lee, John (Pendle)	Shaw, Sir Giles (Pudsey)
Leigh, Edward (Gainsbor'gh)	Shelton, Sir William
Lennox-Boyd, Hon Mark	Shephard, Mrs G. (Norfolk SW)
Lester, Jim (Broxtowe)	Shephard, Colin (Hereford)
Lloyd, Sir Ian (Havant)	Shepherd, Richard (Aldridge)
Lloyd, Peter (Fareham)	Shersby, Michael
Lord, Michael	Sims, Roger
Luce, Rt Hon Sir Richard	Skeet, Sir Trevor
MacGregor, Rt Hon John	Smith, Sir Dudley (Warwick)
MacKay, Andrew (E Berkshire)	Smith, Tim (Beaconsfield)
Maclean, David	Soames, Hon Nicholas
McLoughlin, Patrick	Speed, Keith
McNair-Wilson, Sir Michael	Speller, Tony
McNair-Wilson, Sir Patrick	Spicer, Sir Jim (Dorset W)
Malins, Humfrey	Spicer, Michael (S Worcs)
Mans, Keith	Squire, Robin
Maples, John	Stanbrook, Ivor
Marland, Paul	Stanley, Rt Hon Sir John
Marshall, John (Hendon S)	Steen, Anthony
Marshall, Sir Michael (Arundel)	Stern, Michael
Martin, David (Portsmouth S)	Stevens, Lewis
Mates, Michael	Stewart, Allan (Eastwood)
Maude, Hon Francis	Stewart, Andy (Sherwood)
Mawhinney, Dr Brian	Stewart, Rt Hon Sir Ian
Maxwell-Hyslop, Robin	Stokes, Sir John
Mayhew, Rt Hon Sir Patrick	Sumberg, David
Mellor, Rt Hon David	Summerson, Hugo
Miller, Sir Hal	Taylor, Ian (Esher)
Mills,Iain	Taylor, Sir Teddy
Miscampbell, Norman	Tebbit, Rt Hon Norman
Mitchell, Andrew (Gedling)	Temple-Morris, Peter
Mitchell, Sir David	Thompson, D. (Calder Valley)
Moate, Roger	Thompson, Patrick (Norwich N)
Montgomery, Sir Fergus	Thorne, Neil
Moore, Rt Hon John	Thurnham, Peter
Morris, M (N'hampton S)	Tracey, Richard
Morrison, Sir Charles	Tredinnick, David
Morrison, Rt Hon Sir Peter	Trippier, David
Moss, Malcolm	Trotter, Neville
Mudd, David	Twinn, Dr Ian
Neale, Sir Gerrard	Vaughan, Sir Gerard
Nelson, Anthony	Viggers, Peter
Neubert, Sir Michael	Waldegrave, Rt Hon William
Newton, Rt Hon Tony	Walden, George
Nicholls, Patrick	Walker, Bill (T'side North)
Nicholson, David (Taunton)	Waller, Gary
Nicholson, Emma (Devon West)	Ward, John
Norris, Steve	Wardle, Charles (Bexhill)
Onslow, Rt Hon Cranley	Watts, John

Wells, Bowen	Wood, Timothy
Wheeler, Sir John	Woodcock, Dr. Mike
Whitney, Ray	Yeo, Tim
Widdecombe, Ann	Young, Sir George (Acton)
Wilkinson, John
Wilshire, David	Tellers for the Noes:
Winterton, Mrs Ann	Mr. David Lightbown and
Wolfson, Mark	Mr. John M. Taylor.

Question accordingly negatived.

Main Question put:—

The House divided: Ayes 301, Noes 224.

Division No. 232]	[10.15pm
AYES
Adley, Robert	Davies, Q. (Stamfd & Spald'g)
Aitken, Jonathan	Davis, David (Boothferry)
Alison, Rt Hon Michael	Day, Stephen
Allason, Rupert	Devlin, Tim
Amery, Rt Hon Julian	Dickens, Geoffrey
Amess, David	Dicks, Terry
Arbuthnot, James	Dorrell, Stephen
Arnold, Jacques (Gravesham)	Douglas-Hamilton, Lord James
Arnold, Sir Thomas	Dover, Den
Ashby, David	Dunn, Bob
Aspinwall, Jack	Durant, Sir Anthony
Atkins, Robert	Eggar, Tim
Atkinson, David	Emery, Sir Peter
Baker, Nicholas (Dorset N)	Evans, David (Welwyn Hatf'd)
Baldry, Tony	Evennett, David
Batiste, Spencer	Fairbairn, Sir Nicholas
Beaumont-Dark, Anthony	Fallon, Michael
Bellingham, Henry	Farr, Sir John
Bendall, Vivian	Fenner, Dame Peggy
Bennett, Nicholas (Pembroke)	Field, Barry (Isle of Wight)
Bevan, David Gilroy	Finsberg, Sir Geoffrey
Biffen, Rt Hon John	Fishburn, John Dudley
Blackburn, Dr John G.	Fookes, Dame Janet
Blaker, Rt Hon Sir Peter	Forth, Eric
Body, Sir Richard	Fowler, Rt Hon Sir Norman
Bonsor, Sir Nicholas	Fox, Sir Marcus
Boswell, Tim	Franks, Cecil
Bottomley, Peter	Freeman, Roger
Bottomley, Mrs Virginia	French, Douglas
Bowden, A. (Brighton K'pto'n)	Fry, Peter
Bowden, Gerald (Dulwich)	Gale, Roger
Bowis, John	Gardiner, Sir George
Boyson, Rt Hon Dr Sir Rhodes	Gill, Christopher
Braine, Rt Hon Sir Bernard	Gilmour, Rt Hon Sir Ian
Brandon-Bravo, Martin	Glyn, Dr Sir Alan
Brazier, Julian	Goodlad, Alastair
Bright, Graham	Goodson-Wickes, Dr Charles
Brown. Michael (Brigg & Cl't's)	Gorman, Mrs Teresa
Bruce, Ian (Dorset South)	Gorst, John
Buck, Sir Antony	Grant, Sir Anthony (CambsSW)
Budgen, Nicholas	Green way, Harry (Ealing N)
Burns, Simon	Greenway, John (Ryedale)
Burt, Alistair	Gregory, Conal
Butcher, John	Griffiths, Peter (Portsmouth N)
Butler, Chris	Grist, Ian
Carlisle, John, (Luton N)	Ground, Patrick
Carlisle, Kenneth (Lincoln)	Grylls, Michael
Carrington, Matthew	Hamilton, Neil (Tatton)
Cash, William	Hampson, Dr Keith
Chalker, Rt Hon Mrs Lynda	Hanley, Jeremy
Channon, Rt Hon Paul	Hannam, John
Chapman, Sydney	Hargreaves, A. (B'ham H'll Gr')
Chope, Christopher	Hargreaves, Ken (Hyndburn)
Churchill, Mr	Harris, David
Clark, Rt Hon Alan (Plymouth)	Hawkins, Christopher
Clark, Dr Michael (Rochford)	Hayes, Jerry
Clark, Rt Hon Sir William	Hayhoe, Rt Hon Sir Barney
Clarke, Rt Hon K. (Rushcliffe)	Hayward, Robert
Conway, Derek	Heath, Rt Hon Edward
Coombs, Anthony (Wyre F'rest)	Heathcoat-Amory, David
Coombs, Simon (Swindon)	Heseltine, Rt Hon Michael
Cope, Rt Hon Sir John	Hicks, Mrs Maureen (Wolv' NE)
Couchman, James	Higgins, Rt Hon Terence L.
Currie, Mrs Edwina	Hill, James

Hind, Kenneth	Norris, Steve
Hogg, Hon Douglas (Gr'th'm)	Onslow, Rt Hon Cranley
Hordern, Sir Peter	Oppenheim, Phillip
Howard, Rt Hon Michael	Page, Richard
Howarth, Alan (Strat'd-on-A)	Paice, James
Howarth, G. (Cannock & B'wd)	Parkinson, Rt Hon Cecil
Howell, Rt Hon David (G'dford)	Patnick, Irvine
Howell, Ralph (North Norfolk)	Patten, Rt Hon John
Hughes, Robert G. (Harrow W)	Pattie, Rt Hon Sir Geoffrey
Hunt, Rt Hon David	Pawsey, James
Hunt, Sir John (Ravensbourne)	Porter, Barry (Wirral S)
Hunter, Andrew	Porter, David (Waveney)
Irvine, Michael	Portillo, Michael
Irving, Sir Charles	Powell, William (Corby)
Jack, Michael	Price, Sir David
Jackson, Robert	Raison, Rt Hon Sir Timothy
Janman, Tim	Redwood, John
Jessel, Toby	Renton, Rt Hon Tim
Jones, Gwilym (Cardiff N)	Rhodes James, Sir Robert
Jones, Robert B (Herts W)	Riddick, Graham
Kellett-Bowman, Dame Elaine	Rifkind, Rt Hon Malcolm
Key, Robert	Roberts, Rt Hon Sir Wyn
King, Roger (B'ham N'thfield)	Roe, Mrs Marion
King, Rt Hon Tom (Bridgwater)	Rossi, Sir Hugh
Kirkhope, Timothy	Rost, Peter
Knapman, Roger	Rowe, Andrew
Knight, Greg (Derby North)	Rumbold, Rt Hon Mrs Angela
Knowles, Michael	Ryder, Rt Hon Richard
Knox, David	Sackville, Hon Tom
Lamont, Rt Hon Norman	Sayeed, Jonathan
Lang, Rt Hon Ian	Scott, Rt Hon Nicholas
Latham, Michael	Shaw, David (Dover)
Lawrence, Ivan	Shaw, Sir Giles (Pudsey)
Lee, John (Pendle)	Shelton, Sir William
Leigh, Edward (Gainsbor'gh)	Shephard, Mrs G. (Norfolk SW)
Lennox-Boyd, Hon Mark	Shepherd, Colin (Hereford)
Lester, Jim (Broxtowe)	Shepherd, Richard (Aldridge)
Lloyd, Sir Ian (Havant)	Shersby, Michael
Lloyd, Peter (Fareham)	Sims, Roger
Lord, Michael	Skeet, Sir Trevor
Luce, Rt Hon Sir Richard	Smith, Sir Dudley (Warwick)
MacGregor, Rt Hon John	Smith, Tim (Beaconsfield)
MacKay, Andrew (E Berkshire)	Soames, Hon Nicholas
Maclean, David	Speed, Keith
McLoughlin, Patrick	Speller, Tony
McNair-Wilson, Sir Michael	Spicer, Sir Jim (Dorset W)
McNair-Wilson, Sir Patrick	Spicer, Michael (S Worcs)
Malins, Humfrey	Squire, Robin
Mans, Keith	Stanbrook, Ivor
Maples, John	Stanley, Rt Hon Sir John
Marland, Paul	Steen, Anthony
Marshall, John (Hendon S)	Stern, Michael
Marshall, Sir Michael (Arundel)	Stevens, Lewis
Martin, David (Portsmouth S)	Stewart, Allan (Eastwood)
Mates, Michael	Stewart, Andy (Sherwood)
Maude, Hon Francis	Stewart, Rt Hon Sir Ian
Mawhinney, Dr Brian	Stokes, Sir John
Maxwell-Hyslop, Robin	Sumberg, David
Mayhew, Rt Hon Sir Patrick	Summerson, Hugo
Mellor, Rt Hon David	Taylor, Ian (Esher)
Miller, Sir Hal	Taylor, Sir Teddy
Mills,Iain	Tebbit, Rt Hon Norman
Miscampbell, Norman	Temple-Morris, Peter
Mitchell, Andrew (Gedling)	Thompson, D. (Calder Valley)
Mitchell, Sir David	Thompson, Patrick (Norwich N)
Moate, Roger	Thorne, Neil
Montgomery, Sir Fergus	Thurnham, Peter
Moore, Rt Hon John	Tracey, Richard
Morris, M (N'hampton S)	Tredinnick, David
Morrison, Sir Charles	Trippier, David
Morrison, Rt Hon Sir Peter	Trotter, Neville
Moss, Malcolm	Twinn, Dr Ian
Mudd, David	Vaughan, Sir Gerard
Neale, Sir Gerrard	Viggers, Peter
Nelson, Anthony	Waldegrave, Rt Hon William
Neubert, Sir Michael	Walden, George
Newton, Rt Hon Tony	Walker, Bill (T'side North)
Nicholls, Patrick	Waller, Gary
Nicholson, David (Taunton)	Ward, John
Nicholson, Emma (Devon West)	Wardle, Charles (Bexhill)

Watts, John	Wood, Timothy
Wells, Bowen	Woodcock, Dr. Mike
Wheeler, Sir John	Yeo, Tim
Whitney, Ray	Young, Sir George (Acton)
Widdecombe, Ann
Wilkinson, John	Tellers for the Ayes:
Wilshire, David	Mr. David Lightbown and
Winterton, Mrs Ann	Mr. John M. Taylor.
Wolfson, Mark

NOES
Adams, Mrs Irene (Paisley, N.)	Ewing, Harry (Falkirk E)
Allen, Graham	Fearn, Ronald
Alton, David	Field, Frank (Birkenhead)
Anderson, Donald	Fields, Terry (L'pool B G'n)
Archer, Rt Hon Peter	Fisher, Mark
Armstrong, Hilary	Flannery, Martin
Ashdown, Rt Hon Paddy	Flynn, Paul
Ashley, Rt Hon Jack	Foot, Rt Hon Michael
Ashton, Joe	Foster, Derek
Banks, Tony (Newham NW)	Foulkes, George
Barnes, Harry (Derbyshire NE)	Fraser, John
Barnes, Mrs Rosie (Greenwich)	Fyfe, Maria
Battle, John	Galloway, George
Beith, A. J.	Garrett, John (Norwich South)
Bell, Stuart	Garrett, Ted (Wallsend)
Bellotti, David	Gilbert, Rt Hon Dr John
Benn, Rt Hon Tony	Godman, Dr Norman A.
Bennett, A. F. (D'nt'n & R'dish)	Golding, Mrs Llin
Benton, Joseph	Gordon, Mildred
Bermingham, Gerald	Gould, Bryan
Bidwell, Sydney	Graham, Thomas
Blunkett, David	Grant, Bernie (Tottenham)
Boateng, Paul	Griffiths, Nigel (Edinburgh S)
Boyes, Roland	Griffiths, Win (Bridgend)
Bradley, Keith	Hain, Peter
Bray, Dr Jeremy	Hardy, Peter
Brown, Gordon (D'mline E)	Harman, Ms Harriet
Brown, Nicholas (Newcastle E)	Hattersley, Rt Hon Roy
Brown, Ron (Edinburgh Leith)	Haynes, Frank
Caborn, Richard	Heal, Mrs Sylvia
Callaghan, Jim	Henderson, Doug
Campbell, Ron (Blyth Valley)	Hinchliffe, David
Campbell-Savours, D. N.	Hoey, Kate (Vauxhall)
Canavan, Dennis	Hogg, N. (C'nauld & Kilsyth)
Carlile, Alex (Mont'g)	Home Robertson, John
Can, Michael	Howarth, George (Knowsley N)
Clark, Dr David (S Shields)	Howell, Rt Hon D. (S'heath)
Clarke, Tom (Monklands W)	Howells, Geraint
Clay, Bob	Hoyle, Doug
Clelland, David	Hughes, John (Coventry NE)
Clwyd, Mrs Ann	Hughes, Robert (Aberdeen N)
Cohen, Harry	Hughes, Roy (Newport E)
Cook, Robin (Livingston)	Hughes, Simon (Southwark)
Corbett, Robin	Ingram, Adam
Corbyn, Jeremy	Janner, Greville
Cousins, Jim	Jones, Barry (Alyn & Deeside)
Cox, Tom	Jones, Martyn (Clwyd S W)
Crowther, Stan	Kaufman, Rt Hon Gerald
Cryer, Bob	Kennedy, Charles
Cummings, John	Kilfoyle, Peter
Cunliffe, Lawrence	Kirkwood, Archy
Cunningham, Dr John	Lambie, David
Darling, Alistair	Leadbitter, Ted
Davies, Rt Hon Denzil (Llanelli)	Leighton, Ron
Davies, Ron (Caerphilly)	Lestor, Joan (Eccles)
Davis, Terry (B'ham Hodge H')	Lewis, Terry
Dewar, Donald	Litherland, Robert
Dixon, Don	Livingstone, Ken
Dobson, Frank	Livsey, Richard
Douglas, Dick	Lloyd, Tony (Stretford)
Dunwoody, Hon Mrs Gwyneth	Lofthouse, Geoffrey
Eadie, Alexander	Loyden, Eddie
Eastham, Ken	McAllion, John
Edwards, Huw	McAvoy, Thomas
Evans, John (St Helens N)	McCartney, Ian

Macdonald, Calum A.	Robinson, Geoffrey
McFall, John	Rogers, Allan
McKay, Allen (Barnsley West)	Rooker, Jeff
McKelvey, William	Rooney, Terence
McLeish, Henry	Ross, Ernie (Dundee W)
Maclennan, Robert	Ross, William (Londonderry E)
McMaster, Gordon	Rowlands, Ted
McNamara, Kevin	Ruddock, Joan
McWilliam, John	Sedgemore, Brian
Madden, Max	Sheerman, Barry
Mahon, Mrs Alice	Sheldon, Rt Hon Robert
Marek, Dr John	Shore, Rt Hon Peter
Marshall, David (Shettleston)	Short, Clare
Marshall, Jim (Leicester S)	Sillars, Jim
Martin, Michael J. (Springburn)	Skinner, Dennis
Martlew, Eric	Smith, Andrew (Oxford E)
Meacher, Michael	Smith, C. (Isl'ton & F'bury)
Meale, Alan	Smith, Rt Hon J. (Monk'ds E)
Michie, Bill (Sheffield Heeley)	Smith, J. P. (Vale of Glam)
Mitchell, Austin (G'f Grimsby)	Smyth, Rev Martin (Belfast S)
Molyneaux, Rt Hon James	Snape, Peter
Moonie, Dr Lewis	Soley, Clive
Morgan, Rhodri	Steel, Rt Hon Sir David
Morris, Rt Hon A, (W'shawe)	Steinberg, Gerry
Morris, Rt Hon J. (Aberavon)	Stott, Roger
Mowlam, Marjorie	Strang, Gavin
Mullin, Chris	Straw, Jack
Murphy, Paul	Taylor, Mrs Ann (Dewsbury)
Nellist, Dave	Thompson, Jack (Wansbeck)
Oakes, Rt Hon Gordon	Turner, Dennis
O'Brien, William	Vaz, Keith
O'Hara, Edward	Wallace, James
O'Neill, Martin	Walley, Joan
Orme, Rt Hon Stanley	Warden, Gareth (Gower)
Owen, Rt Hon Dr David	Wareing, Robert N.
Parry, Robert	Welsh, Michael (Doncaster N)
Patchett, Terry	Wigley, Dafydd
Pendry, Tom	Williams, Rt Hon Alan
Pike, Peter L.	Williams, Alan W. (Carm'then)
Prescott, John	Wilson, Brian
Primarolo, Dawn	Winnick, David
Quin, Ms Joyce	Wise, Mrs Audrey
Radice, Giles	Worthington, Tony
Randall, Stuart	Wray, Jimmy
Redmond, Martin	Young, David (Bolton SE)
Rees, Rt Hon Merlyn
Reid, Dr John	Tellers for the Noes:
Richardson, Jo	Mr. Ray Powell and
Robertson, George	Mr. Eric Illsley.

Question accordingly agreed to.

Resolved, That this House welcomes the record extra resources provided for the NHS and the substantial increase in the number of NHS patients treated since the Government came to office in 1979; supports the Government's reforms of the NHS which are already bringing about improvements in patient care; deplores the intellectual bankruptcy of Her Majesty's Opposition which, bereft of any coherent proposals of its own for the modernisation of the National Health Service, is reduced to peddling smears and scares which lower morale amongst NHS staff and cause wholly unnecessary fear amongst patients; notes with approval the Prime Minister's unequivocal statement on the NHS that there will be no charges for hospital treatment, no charges for visits to the doctor, no privatisation of health care, neither in part nor as a whole, now or in the future; and welcomes his unequivocal assurance that Trust hospitals remain a permanent part of the NHS.